The relationship between quality of life, health and care transition: an empirical comparison in an older post-acute population

BACKGROUND: The aim of this study was to explore, via empirical comparison, the relationship between quality of life, as measured by the ICECAP-O capability index (a new instrument designed to measure and value quality of life in older people), with both self-reported health status and the quality of care transition in adults aged 65 and over participating in two post acute rehabilitation programs (outpatient day rehabilitation and the Australian National Transition Care residential program). METHODS: The ICECAP-O was administered to patients receiving either outpatient day rehabilitation (n = 53) or residential transition care (n = 29) during a face to face interview. The relationships between the ICECAP-O and other instruments, including the EQ-5D (a self-reported measure of health status) and CTM-3 (a self-reported measure of the quality of care transitions), the type of post-acute care being received and socio-demographic characteristics were examined. RESULTS: The mean ICECAP-O score for the total sample was 0.81 (SD: 0.15). Patients receiving outpatient day rehabilitation generally reported higher levels of capability, than patients receiving residential transition care (mean 0.82 [SD: 0.15] and 0.79 [SD: 0.164] respectively), however these differences were not statistically significant. The mean EQ-5D score for the total sample was somewhat lower than the ICECAP-O (mean 0.55; SD: 0.27) indicating significant levels of health impairment with the outpatient day rehabilitation group demonstrating slightly higher levels of health status than the transition care group (mean 0.54 [SD: 0.254] and mean 0.49 [SD: 0.30]). The ICECAP-O was found to be positively correlated with both the CTM-3 (Spearman's r =0.234; p ≤ 0.05) and the EQ-5D (Spearman's r = 0.437; p ≤ 0.001). The relationships between the total EQ-5D and CTM-3 scores and the individual attributes of the ICECAP-O indicate health status and quality of care transition in this patient population to be influential in some, but not all aspects of capability. CONCLUSIONS: The correlations between the ICECAP-O, EQ-5D and CTM-3 instruments illustrate that capability is strongly and positively associated with health-related quality of life and the quality of care transitions. However further research is required to further examine the construct validity of the ICECAP-O and to examine its potential for incorporation into economic evaluation.Leah Couzner, Julie Ratcliffe and Maria Crott