The Linkage between Pediatric Quality of Life and Health Conditions: Establishing Clinically Meaningful Cutoff Scores for the PedsQL

Authors

  • I-Chan Huang PhD,

    1. Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida, Gainesville, FL, USA;
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  • Lindsay A. Thompson MD, MS,

    1. Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida, Gainesville, FL, USA;
    2. Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA;
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  • Yueh-Yun Chi PhD,

    1. Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida, Gainesville, FL, USA;
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  • Caprice A. Knapp PhD,

    1. Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida, Gainesville, FL, USA;
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  • Dennis A. Revicki PhD,

    1. Center for Health Outcomes Research, the United BioSource Corporation, Bethesda, MD, USA;
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  • Michael Seid PhD,

    1. Center for Health Care Quality, Division of Health Policy and Clinical Effectiveness, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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  • Elizabeth A. Shenkman PhD

    1. Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida, Gainesville, FL, USA;
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I-Chan Huang, Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida, PO Box 100147, Gainesville, FL 32610-0147, USA. E-mail: ichuang@ufl.edu

ABSTRACT

Objective:  To link pediatric health-related quality of life (HRQOL) and health conditions by establishing clinically meaningful cutoff scores for an HRQOL instrument, the Pediatric Quality of Life Inventory (PedsQL).

Methods:  We conducted telephone interviews with 1745 parents whose children were between 2 and 18 years old and enrolled in the Florida KidCare program and Children's Medical Services Network in 2006. Two anchors, the Children with Special Health Care Needs (CSHCN) Screener and the Clinical Risk Groups (CRGs), were used to identify children with special health-care needs or chronic conditions. We established cutoff scores for the PedsQL's physical, emotional, social, school, and total functioning using the areas under the curves (AUCs) to determine the discriminative property of the PedsQL referring to the anchors.

Results:  The discriminative property of the PedsQL was superior, especially in total functioning (AUC > 0.7), between children with special health-care needs (based on the CSHCN Screener) and with moderate and major chronic conditions (based on the CRGs) as compared to healthy children. For children <8 years, the recommended cutoff scores for using total functioning to identify CSHCN were 83, 79 for moderate, and 77 for major chronic conditions. For children ≥8 years, the cutoff scores were 78, 76, and 70, respectively.

Conclusions:  Pediatric HRQOL varied with health conditions. Establishing cutoff scores for the PedsQL's total functioning is a valid and convenient means to potentially identify children with special health-care needs or chronic conditions. The cutoff scores can help clinicians to conduct further in-depth clinical assessments.

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