The future of hospital quality of care policy: a multi-stakeholder discrete choice experiment in Flanders, Belgium

ObjectiveTo identify what women want in a delivery health facility and how they rank the attributes that influence the choice of a place of delivery.DesignA discrete choice experiment (DCE) was conducted to elicit rural women’s preferences for choice of delivery health facility. Data were analysed using a conditional logit model to evaluate the relative importance of the selected attributes. A mixed multinomial model evaluated how interactions with sociodemographic variables influence the choice of the selected attributes.SettingSix health facilities in a rural subcounty.ParticipantsWomen aged 18–49 years who had delivered within 6 weeks.Primary outcomeThe DCE required women to select from hypothetical health facility A or B or opt-out alternative.ResultsA total of 474 participants were sampled, 466 participants completed the survey (response rate 98%). The attribute with the strongest association with health facility preference was having a kind and supportive healthcare worker (β=1.184, p<0.001), second availability of medical equipment and drug supplies (β=1.073, p<0.001) and third quality of clinical services (β=0.826, p<0.001). Distance, availability of referral services and costs were ranked fourth, fifth and sixth, respectively (β=0.457, p<0.001; β=0.266, p<0.001; and β=0.000018, p<0.001). The opt-out alternative ranked last suggesting a disutility for home delivery (β=−0.849, p<0.001).ConclusionThe most highly valued attribute was a process indicator of quality of care followed by technical indicators. Policymakers need to consider women’s preferences to inform strategies that are person centred and lead to improvements in quality of care during delivery.

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Quality of care experience in aged care: An Australia-Wide discrete choice experiment to elicit preference weights

Social Science & Medicine ◽

10.1016/j.socscimed.2021.114440 ◽

2021 ◽

pp. 114440

Author(s):

Gang Chen ◽

Julie Ratcliffe ◽

Rachel Milte ◽

Jyoti Khadka ◽

Billingsley Kaambwa

Keyword(s):

Quality Of Care ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Aged Care ◽

Care Experience ◽

Preference Weights

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Experts’ preferences for sarcopenia outcomes: a discrete-choice experiment from a working group of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) in collaboration with the European Union of Geriatric Medicine Society (EUGMS)

Aging Clinical and Experimental Research ◽

10.1007/s40520-021-01794-2 ◽

2021 ◽

Author(s):

Charlotte Beaudart ◽

◽

Jürgen M. Bauer ◽

Francesco Landi ◽

Olivier Bruyère ◽

...

Keyword(s):

Quality Of Life ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Musculoskeletal Diseases ◽

Geriatric Medicine ◽

Mixed Logit ◽

The European Union ◽

Domestic Activities

Abstract Background and aims To assess experts’ preference for sarcopenia outcomes. Methods A discrete-choice experiment was conducted among 37 experts (medical doctors and researchers) from different countries around the world. In the survey, they were repetitively asked to choose which one of two hypothetical patients suffering from sarcopenia deserves the most a treatment. The two hypothetical patients differed in five pre-selected sarcopenia outcomes: quality of life, mobility, domestic activities, fatigue and falls. A mixed logit panel model was used to estimate the relative importance of each attribute. Results All sarcopenia outcomes were shown to be significant, and thus, important for experts. Overall, the most important sarcopenia outcome was falls (27%) followed by domestic activities and mobility (24%), quality of life (15%) and fatigue (10%). Discussion and conclusion Compared to patient’s preferences, experts considered falls as a more important outcome of sarcopenia, while the outcomes fatigue and difficulties in domestic activities were considered as less important.

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Investigating the relative value of health and social care related quality of life using a discrete choice experiment

Social Science & Medicine ◽

10.1016/j.socscimed.2019.05.032 ◽

2019 ◽

Vol 233 ◽

pp. 28-37 ◽

Cited By ~ 4

Author(s):

Brendan Mulhern ◽

Richard Norman ◽

Richard De Abreu Lourenco ◽

Juliette Malley ◽

Deborah Street ◽

...

Keyword(s):

Quality Of Life ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Social Care ◽

Relative Value ◽

Health And Social Care ◽

Related Quality ◽

Value Of Health

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Dear policy maker: Have you made up your mind? A discrete choice experiment among policy makers and other health professionals

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462310000048 ◽

2010 ◽

Vol 26 (2) ◽

pp. 198-204 ◽

Cited By ~ 34

Author(s):

Marc A. Koopmanschap ◽

Elly A. Stolk ◽

Xander Koolman

Keyword(s):

Quality Of Life ◽

Cost Effectiveness ◽

Disease Severity ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Healthcare Professionals ◽

Budget Impact ◽

Policy Makers

Objectives: The aim of this study was to get insight in what criteria as presented in Health technology assessment (HTA) studies are important for decision makers in healthcare priority setting.Methods: We performed a discrete choice experiment among Dutch healthcare professionals (policy makers, HTA experts, advanced HTA students). In twenty-seven choice sets, we asked respondents to elect reimbursement of one of two different healthcare interventions, which represented unlabeled, curative treatments. Both treatments were incrementally compared with usual care. The results of the interventions were normal outputs of HTA studies with a societal perspective. Results were analyzed using a multinomial logistic regression model. Upon completion of the questionnaire, we discussed the exercise with policy makers.Results: Severity of disease, costs per quality-adjusted life-year gained, individual health gain, and the budget impact were the most decisive decision criteria. A program targeting more severe diseases increased the probability of reimbursement dramatically. Uncertainty related to cost-effectiveness was also important. Respondents preferred health gains that include quality of life improvements over extension of life without improved quality of life. Savings in productivity costs were not crucial in decision making, although these are to be included in Dutch reimbursement dossiers for new drugs. Regarding subgroups, we found that policy makers attached relatively more weight to disease severity than others but less to uncertainty.Conclusions: Dutch policy makers and other healthcare professionals seem to have reasonably well articulated preferences: six of seven attributes were significant. Disease severity, budget impact, and cost-effectiveness were very important. The results are comparable to international studies, but reveal a larger set of important decision criteria.

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Using a Discrete-Choice Experiment Involving Cost to Value a Classification System Measuring the Quality-of-Life Impact of Self-Management for Diabetes

Value in Health ◽

10.1016/j.jval.2017.06.016 ◽

2018 ◽

Vol 21 (1) ◽

pp. 69-77 ◽

Cited By ~ 5

Author(s):

Donna Rowen ◽

Katherine Stevens ◽

Alexander Labeit ◽

Jackie Elliott ◽

Brendan Mulhern ◽

...

Keyword(s):

Quality Of Life ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Classification System ◽

Choice Experiment ◽

Self Management ◽

Life Impact

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Caregiver preferences for increasing patient survival in advanced melanoma.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.5_suppl.185 ◽

2017 ◽

Vol 35 (5_suppl) ◽

pp. 185-185

Author(s):

A. Brett Hauber ◽

Juan M. González ◽

Joshua Posner ◽

Michael Lees

Keyword(s):

Survival Time ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Symptom Severity ◽

Choice Experiment ◽

Standard Of Care ◽

Advanced Melanoma ◽

Severe Nausea ◽

Incremental Value

185 Background: Patients with advanced cancer and their caregivers may often accept shorter life expectancy to ensure higher quality of remaining months of life. Our objective was to elicit caregiver preferences for quality-adjusted survival associated with treatments for advanced melanoma using a discrete-choice experiment. Methods: Adults in Germany and Sweden caring for people with diagnoses of advanced melanoma completed a web-enabled, discrete-choice experiment. The survey presented caregivers with a series of 10 choice questions, each including three profiles – a pair of hypothetical melanoma treatments and standard of care. Each profile was defined by survival time (24 months, 12 months, 6 months), severity (mild, moderate, severe) of melanoma symptoms, nausea and vomiting, diarrhea, skin problems, and out-of-pocket cost. Treatment profile pairs in choice questions were based on an experimental design with known statistical properties. Standard of care was constant across all choice questions. Regression analysis related respondents’ choice to treatment characteristics and estimate preference weights in each country. Results: 188 respondents in Germany and 202 in Sweden completed the survey. Caregivers choices were consistent with accepting tradeoffs among efficacy, symptom severity, severity of toxicities and cost. Severity of melanoma symptoms was the most important outcome for Swedish caregivers and was approximately as important as survival time for German caregivers. German caregivers placed positive value on each additional month of survival regardless of symptom severity. In Sweden, additional months of survival were of positive value to caregivers except when melanoma symptoms were severe or patients experienced severe nausea, vomiting, and diarrhea concurrently. In all cases where additional months of survival had positive value, the incremental value of each additional month diminished as overall survival increased. Conclusions: Additional months of life with severe symptoms or toxicities may not be viewed as unambiguously good outcomes. Quality of survival is not only a key consideration, but may determine whether a given treatment for melanoma is considered better or worse than standard of care.

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What publicly available quality metrics do hip and knee arthroplasty patients care about most when selecting a hospital in Maryland: a discrete choice experiment

BMJ Open ◽

10.1136/bmjopen-2018-028202 ◽

2019 ◽

Vol 9 (5) ◽

pp. e028202

Author(s):

Lyndsay M O’Hara ◽

Ilaria Caturegli ◽

Nathan N O’Hara ◽

Robert V O’Toole ◽

David F Dalury ◽

...

Keyword(s):

Decision Making ◽

Postoperative Pain ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Knee Arthroplasty ◽

Choice Experiment ◽

Quality Metrics ◽

Hospital Quality ◽

Discharge Instructions ◽

Hip And Knee Arthroplasty

ObjectiveTo quantify which publicly reported hospital quality metrics have the greatest impact on a patient’s simulated hospital selection for hip or knee arthroplasty.DesignDiscrete choice experiment.SettingTwo university-affiliated orthopaedic clinics in the greater Baltimore area, Maryland, USA.ParticipantsOne hundred and twenty-eight patients who were candidates for total hip or knee arthroplasty.Primary and secondary outcome measuresThe effect and magnitude of acceptable trade-offs between publicly reported hospital quality parameters on patients’ decision-making strategies using a Hierarchical Bayes model.ResultsPublicly reported information on patient perceptions of attention to alleviation of postoperative pain had the most influence on simulated hospital choice (20.7%), followed by methicillin-resistantStaphylococcus aureus(MRSA) rates (18.8%). The understandability of the discharge instructions was deemed the least important attribute with a relative importance of 6.9%. Stratification of these results by insurance status and duration of pain prior to surgery revealed that patient demographics and clinical presentation affect the decision-making paradigm.ConclusionsPublicly available information regarding hospital performance is of interest to hip and knee arthroplasty patients. Patients are willing to accept suboptimal understanding of discharge instructions, lower hospital ratings and suboptimal cleanliness in exchange for better postoperative pain management, lower MRSA rates, and lower complication rates.

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