Health-related quality of life in high-cost, high-need populations

To characterize patient-reported health and assess the psychometric performance of health-related quality of life (HRQOL) in high-cost, high-need (HCHN) populations.

Retrospective longitudinal study examining health care utilization, expenditures, and patient-reported health comparing a baseline (year 1) and follow-up year (year 2).

The sample includes adults (n = 46,934) participating in the Medical Expenditure Panel Survey between 2011 and 2016. We estimated HRQOL for each sample member using the physical and mental health scales from the Medical Outcomes Study Short Form 12. We compared HRQOL stratified by HCHN, defined as patients whose baseline (year 1) demographics, utilization, and clinical characteristics predicted top decile health spending in year 2. Analyses assessed the validity, reliability, and responsiveness of physical and, separately, mental health scales.

Among HCHN adults, the physical health scale exhibited robust measure validity, reliability, and responsiveness across all age groups; the mental health scale did not. Mean physical health was 1.25 SDs lower in HCHN vs other patients (37.9 vs 51.0 on a 0-100 scale increasing in self-perceived health; pooled SD, 10.5). Regressions indicated that a 0.5-SD increase in year 1 physical health among HCHN adults predicted a 5-percentage-point (10%) decrease in the probability of top decile health spending in year 2. In contrast to health care spending, HRQOL did not exhibit reversion to the mean in HCHN patients.

Patient-reported health outcomes remain poor in HCHN populations, even after health care utilization recedes. HRQOL is a promising outcome measure for HCHN-focused payment and delivery interventions.