Background The EQ-5D is one of the most frequently used generic, preference-based instruments for measuring the health utilities of patients in economic evaluations. It is recommended for health technology assessment by the National Institute for Health and Clinical Excellence. Because the EQ-5D plays such an important role in economic evaluations, useful information on its responsiveness to detect meaningful change in health status is required. Objective This study systematically reviewed and synthesized evidence on the responsiveness of the EQ-5D to detect meaningful change in health status for clinical research and economic evaluations. Methods We searched the EuroQol website, PubMed, PsychINFO, and EconLit databases to identify studies published in English from the inception of the EQ-5D until August 15, 2014 using keywords that were related to responsiveness. Studies that used only the EQ-VAS were excluded from the final analysis. Narrative synthesis was conducted to summarize evidence on the responsiveness of the EQ-5D by conditions or physiological functions. Results Of 1,401 studies, 145 were included in the narrative synthesis and categorized into 19 categories for 56 conditions. The EQ-5D was found to be responsive in 25 conditions (45%) with the magnitude of responsiveness varying from small to large depending on the condition. There was mixed evidence of responsiveness in 27 conditions (48%). Only four conditions (7%) (i.e., alcohol dependency, schizophrenia, limb reconstruction, and hearing impairment) were identified where the EQ-5D was not responsive. Conclusion The EQ-5D is an appropriate measure for economic evaluation and health technology assessment in conditions where it has demonstrated evidence of responsiveness. In conditions with mixed evidence of responsiveness, researchers should consider using the EQ-5D with other condition-specific measures to ensure appropriate estimates of effectiveness. These conditions should be a main focus for future research using the new EQ-5D version with 5 response levels.

These data did not detect a consistent significant positive association between montelukast and NE in children with asthma.

Purpose of the Study Care challenges have been described for hospitalized morbidly obese (MO) patients. These challenges likely persist post-discharge. As a result, nursing homes (NH) may be reluctant to admit these patients, potentially leaving them “stranded in hospitals” with subsequent health deterioration and increased costs. This study sought to identify issues NHs consider in admissions decisions for MO patients transitioning out of hospitals. Design and Methods: IRB-approved surveys were mailed to nursing directors at federally-certified NHs in Arkansas (n=234) and Pennsylvania (n=710) to collect NH experience in the admission of patients weighing ≥325 pounds. Data were analyzed using descriptive and inferential statistics to summarize and identify predictors of MO patient admissions decisions. Results In total, 360 surveys were returned (38.1% response rate). Although two-thirds of respondents reported patient size as an admission barrier, only 6% reported that MO patients were always refused admission. Adjusted analysis showed that NHs with adequate staff were significantly (p=0.04) less likely to report obesity as an admission barrier while NHs reporting concerns about availability of bariatric equipment were significantly (p<0.0001) more likely to report obesity as a barrier. Implications Lack of staff and bariatric equipment in NHs appears to negatively affect the care transition of MO patients out of the hospital to NHs. Additional research, including examination of current regulations and reimbursement policies, should be undertaken to understand NH staffing and equipment acquisition decisions in light of the current obesity epidemic. Such research has implications for the optimal care of obese individuals during times of transition.

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