Changes in Health-Related Quality of Life Before and After a 12-month Enhanced Primary Care Model Among Chronically Ill Primary Care Patients in Australia.
Abstract Purpose: Evidence suggests that Patient-centred Medical Home (PCMH) model facilitates person-centred care and improves health-related quality of life for patients with chronic illness. This study aims to evaluate changes in health-related quality of life (HRQoL), before and after enrolment into a 12-month integrated care program called ‘WellNet’. Methods: This study includes 616 eligible consented patients aged 40 years and above with one or more chronic conditions from six general practices in Sydney, Australia. The WellNet program included a team of general practitioners (GPs) and specially trained chronic disease management (CDM) clinical coordinators (CCs) providing patient-tailored CDM plans configured to individual risk and complexity. HRQoL was recorded using the validated EuroQol EQ-5D-5L instrument. A case-series study design with repeated measures ANCOVA was used to assess changes in EQ-5D index scores after controlling for baseline covariates. Per-protocol analysis and imputed model, the latter using Markov Chain Monte Carlo (MCMC) algorithm of multiple imputation were analysed. A backward stepwise multivariate linear regression models were conducted to determine predictors of EQ-5D index scores at follow-up. In addition to EQ-5D instrument, a supplementary analysis was carried out with use of the short versions of Knee and/or Hip disability and osteoarthritis outcome scores (KOOS and HOOS) reported by patients diagnosed with osteoarthritis. Results: Out of 616 patients, 417 (69%) reported EQ-5D scores at follow-up. Almost half (48%) of the WellNet patients reported improved EQ-5D index scores at follow-up. After controlling for baseline covariates, the adjusted mean difference was statistically significant whilst also meeting the bare minimal clinically important difference (MCID) with a change of 0.03 (95% CI 0.01, 0.05). However, the imputed model failed to meet statistical significance. The multivariate regression models determined that baseline EQ-5D scores, positive diagnosis of a respiratory illness, and private health insurance status were significant predictors of HRQoL at follow-up. There were significant improvements across both KOOS and HOOS assessments, specifically, the pain and symptom scores in both scales met statistical significance in addition to meeting the MCID.Conclusion: Patient-tailored CDM plans designed by team of GPs and CDM clinical coordinators could lead to better HRQoL among primary care patients.