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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 across Sydney, Australia. The WellNet program included a team of general practitioners (GPs) and clinical coordinators (CCs) providing patient-tailored care plans configured to individual risk and complexity. HRQoL was recorded using the validated EuroQol five dimensions five levels (EQ-5D-5L) instrument at baseline and 12 months. Additionally, patients diagnosed with osteoarthritis also reported HRQoL using short versions of Knee and/or Hip disability and osteoarthritis outcome scores (KOOSjr and HOOSjr). A case-series study design with repeated measures analysis of covariance (ANCOVA) was used to assess changes in mean differences of EQ-5D index scores after controlling for baseline covariates. Additionally, backward stepwise multivariable linear regression models were conducted to determine significant predictors of EQ-5D index scores at follow-up.
Results: Out of 616 patients, 417 (68%) 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). The multivariable regression models determined that baseline EQ-5D scores and positive diagnosis of a respiratory illness 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 chronic disease management (CDM) plans designed by team of GPs and CDM clinical coordinators could lead to better HRQoL among primary care patients.
Keywords
Quality of life, EuroQol (EQ-5D), multimorbidity, chronic disease, integrated care, collaborative care, chronic care model, Australia
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CURRENT STATUS: Published
View the published article at Health and Quality of Life Outcomes.
Version 4
Posted 13 Aug, 2020
No community comments so far
Reviewer #1 agreed
On 13 Aug, 2020
Review #1 received
Received 13 Aug, 2020
Editorial decision: Accept
On 13 Aug, 2020
Editor assigned
On 11 Aug, 2020
Reviewers invited
Invitations sent on 11 Aug, 2020
Submission checks complete
On 10 Aug, 2020
Editor invited
On 10 Aug, 2020
No comments provided
Review #1 received
Received 06 Aug, 2020
Editorial decision: Minor Revision
On 06 Aug, 2020
Editor assigned
On 30 Jul, 2020
Reviewers invited
Invitations sent on 30 Jul, 2020
Reviewer #1 agreed
On 30 Jul, 2020
Submission checks complete
On 29 Jul, 2020
Editor invited
On 29 Jul, 2020
No comments provided
Review #1 received
Received 26 Jul, 2020
Editorial decision: Minor Revision
On 26 Jul, 2020
Reviewer #1 agreed
On 04 Jul, 2020
Reviewers invited
Invitations sent on 24 Jun, 2020
Editor assigned
On 24 Jun, 2020
Submission checks complete
On 23 Jun, 2020
Editor invited
On 23 Jun, 2020
No comments provided
Editorial decision: Major Revision
On 19 Jun, 2020
Review #2 received
Received 12 Jun, 2020
Review #1 received
Received 29 May, 2020
Reviewer #3 agreed
On 25 May, 2020
Reviewer #2 agreed
On 23 May, 2020
Reviewers invited
Invitations sent on 17 May, 2020
Reviewer #1 agreed
On 17 May, 2020
Editor assigned
On 12 May, 2020
Submission checks complete
On 11 May, 2020
Editor invited
On 11 May, 2020
First submitted
On 08 May, 2020
Metrics
Comments: 0
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See the published version of this preprint at Health and Quality of Life Outcomes.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Health and Quality of Life Outcomes.
Version 4
Posted 13 Aug, 2020
No community comments so far
Reviewer #1 agreed
On 13 Aug, 2020
Review #1 received
Received 13 Aug, 2020
Editorial decision: Accept
On 13 Aug, 2020
Editor assigned
On 11 Aug, 2020
Reviewers invited
Invitations sent on 11 Aug, 2020
Submission checks complete
On 10 Aug, 2020
Editor invited
On 10 Aug, 2020
No comments provided
Review #1 received
Received 06 Aug, 2020
Editorial decision: Minor Revision
On 06 Aug, 2020
Editor assigned
On 30 Jul, 2020
Reviewers invited
Invitations sent on 30 Jul, 2020
Reviewer #1 agreed
On 30 Jul, 2020
Submission checks complete
On 29 Jul, 2020
Editor invited
On 29 Jul, 2020
No comments provided
Review #1 received
Received 26 Jul, 2020
Editorial decision: Minor Revision
On 26 Jul, 2020
Reviewer #1 agreed
On 04 Jul, 2020
Reviewers invited
Invitations sent on 24 Jun, 2020
Editor assigned
On 24 Jun, 2020
Submission checks complete
On 23 Jun, 2020
Editor invited
On 23 Jun, 2020
No comments provided
Editorial decision: Major Revision
On 19 Jun, 2020
Review #2 received
Received 12 Jun, 2020
Review #1 received
Received 29 May, 2020
Reviewer #3 agreed
On 25 May, 2020
Reviewer #2 agreed
On 23 May, 2020
Reviewers invited
Invitations sent on 17 May, 2020
Reviewer #1 agreed
On 17 May, 2020
Editor assigned
On 12 May, 2020
Submission checks complete
On 11 May, 2020
Editor invited
On 11 May, 2020
First submitted
On 08 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Health and Quality of Life Outcomes.
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 across Sydney, Australia. The WellNet program included a team of general practitioners (GPs) and clinical coordinators (CCs) providing patient-tailored care plans configured to individual risk and complexity. HRQoL was recorded using the validated EuroQol five dimensions five levels (EQ-5D-5L) instrument at baseline and 12 months. Additionally, patients diagnosed with osteoarthritis also reported HRQoL using short versions of Knee and/or Hip disability and osteoarthritis outcome scores (KOOSjr and HOOSjr). A case-series study design with repeated measures analysis of covariance (ANCOVA) was used to assess changes in mean differences of EQ-5D index scores after controlling for baseline covariates. Additionally, backward stepwise multivariable linear regression models were conducted to determine significant predictors of EQ-5D index scores at follow-up.
Results: Out of 616 patients, 417 (68%) 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). The multivariable regression models determined that baseline EQ-5D scores and positive diagnosis of a respiratory illness 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 chronic disease management (CDM) plans designed by team of GPs and CDM clinical coordinators could lead to better HRQoL among primary care patients.
Figure 1
Figure 2
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