title: The relative impact of chronic conditions and multimorbidity on health-related quality of life in Ontario long-stay home care clients.
abstract: To examine the relative impact of 16 common chronic conditions and increasing morbidity on health-related quality of life (HRQL) in a population-based sample of home care clients in Ontario, Canada.
  
  
  
  Participants were adult clients assessed with the Resident Assessment Instrument for Home Care (RAI-HC) between January and June 2009 and diagnosed with one (or more) of 16 common chronic conditions. HRQL was evaluated using the Minimum Data Set-Health Status Index (MDS-HSI), a preference-based measure derived from items captured in the RAI-HC. Multivariable linear regression models assessed the relative impact of each condition, and increasing number of diagnoses, on MDS-HSI scores.
  
  
  
  Mean (SD) MDS-HSI score in the study population (n = 106,159) was 0.524 (0.213). Multivariable analysis revealed a statistically significant (p < 0.05) and clinically important (difference ≥ 0.03) decrease in MDS-HSI scores associated with stroke (-0.056), osteoarthritis (-0.036), rheumatoid arthritis (-0.033) and congestive heart failure (CHF, -0.030). Differences by age and sex were observed; most notably, the negative impact associated with dementia was greater among men (-0.043) than among women (-0.019). Further, HRQL decreased incrementally with additional diagnoses. In all models, chronic conditions and number of diagnoses accounted for a relatively small proportion of the variance observed in MDS-HSI.
  
  
  
  Clinically important negative effects on HRQL were observed for clients with a previous diagnosis of stroke, osteo- and rheumatoid arthritis, or CHF, as well as with increasing levels of multimorbidity. Findings provide baseline preference-based HRQL scores for home care clients with different diagnoses and may be useful for identifying, targeting and evaluating care strategies toward populations with significant HRQL impairments.
authors.affiliation: Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.|Health System Performance Research Network (HSPRN), Toronto, ON, Canada.
authors.forename: Luke
authors.initials: L
authors.lastname: Mondor
authors.affiliation: Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.|Health System Performance Research Network (HSPRN), Toronto, ON, Canada.|Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
authors.forename: Colleen J
authors.initials: CJ
authors.lastname: Maxwell
authors.affiliation: Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.|Health System Performance Research Network (HSPRN), Toronto, ON, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3MS, Canada.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Bronskill
authors.affiliation: Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.|Health System Performance Research Network (HSPRN), Toronto, ON, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3MS, Canada.|Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
authors.affiliation: Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada. walter.wodchis@utoronto.ca.|Health System Performance Research Network (HSPRN), Toronto, ON, Canada. walter.wodchis@utoronto.ca.|Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3MS, Canada. walter.wodchis@utoronto.ca.|Toronto Rehabilitation Institute, Toronto, ON, Canada. walter.wodchis@utoronto.ca.
authors.forename: Walter P
authors.initials: WP
authors.lastname: Wodchis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity / Q000639:trends*; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D018434:Sickness Impact Profile; D055815:Young Adult
keywords: Chronic disease; Health status; Home care services; Ontario/epidemiology; Quality of life