Online Program

Factors associated with worsening health-related quality of life among a Medicare Advantage population

Monday, November 2, 2015

Xindi Fang, MPH, Clinical Analytics, Humana, Inc., Louisville, KY
Jonathan Pena, MS, Clinical Analytics, Humana Inc., Louisville, KY
S.Lane Slabaugh, PharmD, MBA, Humana, Inc., Louisville, KY
Tristan Cordier, MPH, Department of Clinical Analytics/Clinical Insights & Outcomes Team, Humana Inc., Atlanta, GA
Gil Haugh, MS, Department of Clinical Analytics/Clinical Insights & Outcomes Team, Humana, Inc., Louisville, KY
Todd Prewitt, MD, FAAFP, Clinical Best Practices | Health Guidance Organization, Humana Inc, Louisville, KY
Vipin Gopal, Ph.D, MBA, Clinical Analytics, Humana, Louisville, KY

Health related quality of life (HRQOL) is an important predictor of health outcomes and healthcare costs. This study explored predictors of worsening HRQOL using the Healthy Days instrument, which is included in the Health Outcomes Survey (HOS). The HOS is administered to a random sample of Medicare Advantage enrollees each year and repeated two years later. Healthy Days measures recent physically and mentally unhealthy days (PUHD and MUHD).

Population and Study Design

Study participants were members of the 2011 HOS cohort in a large Medicare Advantage plan who reported 0-13 PUHD or MUHD. Decision Tree Analysis identified the most important predictors of an increase between 2011 and 2013 to ≥14 PUHD or MUHD.  Variables for demographics, functional/health status, utilization, and clinical conditions were assigned a relative Variable Importance (VI) value.


The final models applied to 5,100 survey respondents with PUHD data (11.3% reported an increase) and 5,526 with MUHD data (6.9% reported an increase). The most important predictor was less than good baseline general health status (VI=1). Difficulties walking at baseline (VI=0.63), diagnosis of musculoskeletal back or neck pain (VI=0.5), low income (VI=0.23), and cardiovascular disease (VI=0.18) were important predictors of increased PUHD. Depression (VI=0.73) disability (VI=0.45), difficulties bathing (VI=0.22) or walking (VI=0.18) at baseline, and age ≥83 years (VI=0.21) at baseline were important predictors of increased MUHD.  


People with less than good baseline general health, functional limitations, chronic conditions, low income, or advanced age may be at risk of worsening HRQOL.

Learning Areas:

Provision of health care to the public
Public health or related research

Learning Objectives:
Describe demographics, chronic conditions, and self-reported functional and health status to predict worsening HRQOL in a Medicare Advantage population.

Keyword(s): Community Health Assessment

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am one of the project leaders and have contributed substantially to the accomplishment of the project. I graduated from Yale School of Public Health with an MPH degree in Epidemiology. My former research experience includes mental health and QoL among elderly living with HIV/AIDS and community health program evaluation.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.