Measuring Health Status in Long-Term Residential Care: Adapting the Veterans RAND 12 Item Health Survey (VR-12©)

ABSTRACT

Objectives: Measuring the perceived mental and physical health status of older adults living in long-term residential care (LTRC) is central to patient-centered care. This study examined the qualitative content validity of the Veterans RAND 12 Item Health Survey (VR-12) for LTRC and, based on the findings, the authors developed an adapted version of the generic patient-reported outcome measure for this population.

Methods: Content validity was evaluated in two steps: (1) initial resident feedback (n = 9) and research team consensus discussions and (2) cognitive interviews with residents (n = 18) and a research team consensus discussion. The cognitive interviews examined comprehension, acceptability, and relevance of the VR-12 items.

Results: Two VR-12 items had limited acceptability in the LTRC setting, the reference to “work” in items was irrelevant to residents, and the lack of a frame of reference (“During the past week … ”) impacted comprehension of several items.

Conclusions: Study findings informed the development of an adapted version of the VR-12 for older adults living in Canadian LTRC homes and provided content validity evidence regarding its relevance and appropriateness for this population.

Clinical implications: Measuring the health status of older adults living in LTRC can help to monitor changes in health status over time and support person-centered care.

KEYWORDS:

• Long-term care
• quality of life
• patient-reported outcome measures (PROMs)
• cognitive interviewing
• content validity
• person-centered care
• older adults

Acknowledgments

The authors wish to thank British Columbia’s Seniors Advocate, Isobel Mackenzie, for her vision for a province-wide approach to measuring the quality of the experiences of all frail older adults living in LTCR settings in British Columbia and for her support for simultaneous collection of health-related quality of life assessments from the perspective of these same LTC residents.Isobel Mackenzie’s Office of the Seniors Advocate (OSA) of BC provided the funding for the provincially coordinated survey and the BC Office of Patient-Centered Measurement planned and implemented the survey. We are grateful for their support of this study. Special thanks to Lillian Parsons, Project Manager for the OSA’s Long Term Residential Care survey, for her valuable contributions to this study, including conducting the initial feedback interviews, informing the development of the subsequent cognitive interview guide, and assisting with resident participant recruitment. The authors also gratefully acknowledge the LTRC residents for participating in the cognitive interviews and the LTRC staff who assisted our research team during the recruitment process. Finally, the authors wish to thank the three trained student volunteers who interviewed the residents.

Author contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Rozanne Wilson, PhD. The first draft of the manuscript was written by Rozanne Wilson, PhD and all authors commented on/revised versions of the manuscript critically for important intellectual content. All authors read and approved the final manuscript.

Clinical implications

• Existing patient-reported outcome measures (PROMs) may not be suitable for people living in LTRC homes; therefore, establishing content validity in new populations is central for the ongoing validation of an existing PROM.

• Qualitative content validity was evaluated for the VR-12 for use in Canadian LTRC homes and the adapted version of this tool (VR-12(LTRC-C)) may be used by clinicians to assess perceived physical and mental health status among LTRC residents.

• Access to a generic PROM that measures the health status of older adults living in the LTRC setting has important clinical implications, including supporting the provision of person-centered care, monitoring changes in health status over time, and providing a better understanding of health care utilization in this population.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplemental material

Supplemental data for this article can be accessed on the publisher’s website.

Notes

1. This paper is focused on the use of a PROM to assess the perceived health status of older adults living in LTRC. Acknowledging the existing conceptual confusion associated with the term HRQoL (i.e., health status and QOL are used interchangeably when they are distinct constructs (Moons, 2004)) and the current lack of a clear definition of HRQL in the literature (Karimi & Brazier, 2016; Moons, 2004), this paper understands HRQoL as the authors use the term HRQoL to mean an individual’s subjective experience of the impact that their health has on physical, mental, and social domains (Hand, 2016; Testa & Simonson, 1996; Wilson, 1995). This definition is in-line with the World Health Organization (WHO) definition of health.(Huber et al., 2011).

2. The literature describes the VR-12 as a measure of HRQoL or a measure of health status. To avoid term confusion, this paper refers to the VR-12 as HRQoL instrument that is used to measure health-related domains (i.e., health status).

3. For-profit organizations are required to pay a small fee.

Additional information

Funding

This work was jointly supported by the Canadian Frailty Network (CFN) (known previously as Technology Evaluation in the Elderly Network, TVN), which is supported by the Government of Canada through the Networks of Centers of Excellence program, and by the BC Office of Patient-Centered Performance Measurement and Improvement [2016 Interdisciplinary Fellowship awarded to Rozanne Wilson, PhD under the supervision of Richard Sawatzky, PhD]. This research was undertaken, in part, thanks to funding from the Canada Research Chairs program in support of Richard Sawatzky, PhD Canada Research Chair in Person-Centered Outcomes.