Predicting health-related quality of life among older patients: an external validation of the Health Assessment Tool (HAT) in Swedish primary care
Emmanouil Kokoroskos, Francesco Innocenti, Ahmad Abbadi, Cecilia Fagerström, Anders Wimo, Christina Olsson, Laura Fratiglioni, Davide Liborio Vetrano, Caroline Wachtler, Amaia Calderón-LarrañagaAbstract
Background
As populations age, primary care (PC) requires tools that capture multidimensional health and patient-centred outcomes. Health-related quality of life (HRQoL) is a key indicator of well-being in older adults but is rarely used to evaluate the predictive performance of geriatric assessment tools. We aimed to externally validate the Health Assessment Tool (HAT) in Swedish PC by examining its ability to discriminate between HRQoL levels at baseline and predict changes over time.
Methods
This multicentre prospective cohort study included 1005 adults aged ≥60 years from six Swedish PC centres (November 2022–December 2024). HAT scores were derived from five indicators: personal and instrumental activities of daily living, gait speed, cognitive function and number of chronic diseases. HRQoL was measured using EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) and EuroQol Visual Analogue Scale (EQ-VAS) at baseline and 6–12 months’ follow-up. Predictive performance was evaluated using the area under the receiver operating characteristic curve (AUC) values for both cross-sectional HRQoL levels and clinically meaningful changes over time.
Results
The HAT demonstrated moderate to good predictive performance across HRQoL outcomes. Cross-sectional AUCs ranged from 0.80 to 0.81 for EQ-5D-5L (10th and 15th percentiles) and 0.71–0.74 for EQ-VAS (25th and 40th percentiles). For longitudinal improvements, AUCs were lower for predicting 10% and 15% increases in EQ-5D-5L (0.69–0.74). In contrast, HAT showed moderate to good predictive capacity for 25% and 40% increases in EQ-VAS (0.71–0.80). HAT consistently outperformed its individual components.
Conclusions
The HAT shows predictive validity for HRQoL in older PC patients. Its integration into routine assessments may support the early identification of patients with poor HRQoL and more personalised care planning.