Study of observed and self-reported HRQL in older frail adults found group-level congruence and individual-level differences

OBJECTIVE: To evaluate the consistency of self-reported health-related quality of life (HRQL) using the Health Utilities Index Mark 2 (HUI2) with observer rated HRQL using the Minimum Data Set Health-Status Index (MDS-HSI). STUDY DESIGN AND SETTING: Frail older home care clients in Calgary Alberta and Wayne County, Michigan responded to HUI2 questionnaires and were assessed using the Minimum Data Set Home Care tool (n=514). HRQL scores were calculated and compared for the HUI2 and the MDS-HSI. The intraclass correlation coefficient (ICC) was used to assess individual level agreement. RESULTS: The MDS-HSI provided HRQL scores that consistently averaged 0.10 points higher than HUI2 self-reported HRQL scores overall and within client characteristics. The ICC was 0.46 in the full population but increased to 0.63 when 10% of the sample with the largest discrepant scores was removed. Pain and emotion health attributes showed the lowest level of agreement. CONCLUSION: The MDS-HSI and HUI2 provide analogous group-level results but only moderate individual-level agreement. When HUI2 survey data are not available, the MDS-HSI can be used to substitute for the HUI2 in group-level comparisons but not for individual clinical evaluation comparisons.