Rationale. CareOregon is a Medicaid provider of healthcare services in Oregon. Previous investigations indicated that the CareOregon complex care management (CCCM) program lowered plan-supported utilization and cost but data on outcomes for patients were lacking. Objectives. To examine the usefulness of a health-related quality of life (HRQL) measure, the Health Utilities Index (HUI), in an evaluation of a patient-management program. Methodology. CareOregon is using the Health Utilities Index Marks 2 (HUI2) and 3 (HUI3) to measure of patient outcome in an evaluation of the CCCM program. A consecutive series of 165 new enrollees in CCCM were assessed in telephone interviews using HUI at baseline with follow-up interviews at 4 months. In addition, 37 patients not assigned to CCCM were also interviewed at baseline and at 4 months. HUI3 includes 8 attributes (vision, hearing, speech, ambulation, dexterity, emotion, cognition, pain) with 5 or 6 levels per attribute. Overall HUI3 scores are on a scale in which dead = 0 and perfect health = 1. Differences/changes of 0.03 or more in overall score are regarded as clearly clinically important (CID). Results. The response rate was 100%. 73% of patients were female; the average age was 58. Prevalent chronic conditions included asthma (44%), depression (63%), hypertension (66%), and arthritis (68%). At baseline, HUI3 identified substantial burdens in pain, cognition, emotion, dexterity, and ambulation. The mean overall HUI3 score at baseline for those assigned to CCCM was 0.19; the score for those not assigned to CCCM was 0.25. At 4 months the mean HUI3 scores were 0.23 (CCCM) and 0.25 (non-CCCM). The change in the mean for the CCCM cohort was clinically important. Fifty percent of CCCM patients improved, 40% declined, and 10% were stable over the 4 month period; for the non-CCCM cohort the results were 43%, 49%, and 8%. Conclusions. HUI provided information confirming the high burden of illness in patients assigned to CCCM. Burdens in ambulation, emotion, and pain were already well recognized but the quantification of those burdens was useful. The burden in cognition, however, had not been recognized and has important implications for the organization of care for and management of CCCM patients. The gain in overall HRQL seen over the 4-month period in CCCM patients provide preliminary evidence that reductions in utilization associated with CCCM are apparently not at the expense of patient outcome. A measure of HRQL, HUI, was useful for program evaluation
