Which Patients gain more from short-term planned hospitalization?

BACKGROUND: The measurement of health-related quality of life (HRQoL) has become one of the most important components in the evaluation of healthcare outcomes. The EQ-5D-5L is an econometric tool to transform HRQoL into Quality Adjusted Life Year (QALY). The study aims to measure the health gain, expressed in QALY, provided by an Italian clinic. METHODS: A retrospective study was conducted on 137 geriatric patients admitted, for short-term planned rehabilitation hospitalization, from March 2018 to March 2020. Patients completed the EQ-5D-5L questionnaire at both admission and discharge. We calculated QALY from the difference between EQ-5D-5L at discharge and admission, assuming that health gains (discounted at the rate of 3.5%) accumulate up to one year after discharge. A risk adjustment has been done through the Cumulative Illness Rating Scale (CIRS). We stratified our sample by gender, age, BMI and clinical severity. Descriptive (median and interquartile range) and statistical (Mann-Whitney and Dunn's Test) analysis was carried out using STATA. RESULTS: In our sample (62.8% female) the median age was 82[15] years old. The median length of stay was 16[17] days. Patients gained 0.14[0.19] QALY: this was greater (p < 0.05) for female (0,15[0,14]) than males (0,12[0,14]). According to age groups, patients >75 years old had a lower QALY (0.12[0.26]) than both patients ≤65 years (0.16[0.15]) and those between 65 and 75 years (0.15[0.12]), while patients younger than 65 years had a higher QALY gain than the other two groups (p > 0.05). The obese class I (0.31[0.46]) gained more QALY than the other BMI classes (p < 0,05), except that obese class II. Patients with a Severity Index of CIRS higher than the median of our sample had a greater health gain (0.18[0.20] vs. 0.12[0.20]) (p > 0.05). CONCLUSIONS: The EQ-5D-5L allowed us to quantify the ‘health gain’ obtained by patients through its transformation into QALY. The best results were obtained in female and obese class I patients. KEY MESSAGES: • The outcome assessment is essential when performing healthcare. • The QALY allows us to assess quantitative and qualitative life expectancy's increases provided by healthcare.