Andrew Bateman PhD MCSPOliver Zangwill Centre for Neuropsychological Rehabilitation

Clinical Lead for NeuroRehab in CCS

Affiliated Lecturer, Dept of Psychiatry, University of Cambridge

Health Education East of England Quality Improvement Fellow

Clinical Use of the Euroqol EQ5D-5L in Community Rehabilitation and Musculoskeletal Physiotherapy services:

Item ordering, Item Bias and Disordered Thresholds

outline

Overview of eq5d-5l – what it is an why I’m using it

My experiences and some findings from our dataset

Use of RMSEA

Reasons for selecting EQ5D a)it was in the OF, b)NHS England also still promotingc)Chartered Soc Physio push

CGs now responsible for commissioningservices, to include outcomes in contract?

How to collate data?How to analyse data?

“Overarching indicator 2.21 Domain 2 seeks to capture how successfully the NHS is supporting people with long-term conditions to live as normal a life as possible. The overarching indicator ‘health-related quality of life for people with long-term conditions’ allows the Secretary of State for Health to understand whether health-related quality of life is improving over time for the population with long-term conditions”.

The EQ5D-5L

Describes a health state “today”

Health related quality of life

& favoured tool inHealth economics

Five questions plus

an overall health“thermometer”

UK

11111 1.000

11112 0.879

11113 0.848

11114 0.635

11115 0.414

11121 0.837

11122 0.768

11123 0.750

11124 0.537

11125 0.316

11131 0.796

11132 0.740

11133 0.725

11134 0.512

11135 0.291

11141 0.584

11142 0.527

11143 0.513

A list of 3127 values is available.

The values are set on a scale where 1 = full health through to 0 = death(minus values are states worse than death e.g. coma or severe intractable pain)

So a Health State 11111 = 1 (Full health)

55555 = -0.594 (State worse than death)

The previous example: 2 3 4 2 1 = 0.516(or as a percentage of full health 51.6%)

Using the EQ-5D-5L Value Sets

Portion of EQ-5D-5L Value Set

Demographics of the 3293 Patients incuded in analysis:Group (17-60) (61-80) (80+)REHAB 299 882 725MATS 561 279 44MSK 408 153 14

Gender %MREHAB 44 41 34MATS 45 (ALL AGES)MSK 38 (ALL AGES)

rehab

MSK patients

item threshold plot illustrates different ordering of item difficulties in Rehab and MSK serviceThe order of item difficulties reflect the priorities of community rehabilitation –ie people seeking support to return to Usual Activities and improve Mobility

Rehab person item thresholds: 94% targettingMean scores per age group are sig different (F=20.12, p<.001), Younger group reporting worse “qol”

MATS N=902, 98% targetting, Age differences, eldest ANOVA F=3.86, p=0.02Oldest group (small n)reporting worst qol,

RMSEA a supplementary statistic

http://www.rasch.org/rmt/rmt254d.htmIts formula can be shown to equal:

for large sample size, RMSEA is used as a supplementary fit statistic, where a value of <0.02 is indicative of fit" [Tennant ibid]

√[(χ2/df - 1) /(N - 1)] 0.0422 REHAB (n=1883)

0.0424 MATS (n=884)

0.0361 MSK (n=576)

0.0539 ALL (n=3293)

0.0529 all (un rescored n= 3331)

Future analysesLocality differences, link to staffing density?Comparison between health conditionsRepeated measurement data calibrated for

age effectsAutomate analysis into performance

dashboardHealth economics (but “there’s no F in

utility”?)Refs http://www.scoop.it/t/eq-5d

So problem #1 is that we haven’t really sorted out NHS outcome

measurement (yet)We agree about importance of proms & prems Importance of data collation system in CCSEMPHASISED in the NHS Outcomes Framework

but analysis approach not establishedNeed for ongoing collaborations with

psychometric and statistical colleagues

Conclusion

Some problems (with bias and thresholds) but good targetting

Generic PROMS like EQ5D useful for thinking about prioritising services to meet needs of patients

Collaboration for Leadership in Applied Health Research and Care

Thank you for your attention!

Andrew.bateman@ozc.nhs.ukwww.ozc.nhs.uk

When shall we meet next?

OZC training events – see flyer – get on distribution list

Keep in touch!Twitter @ozcboss

LinkedInScoop.it