PP3 WHAT DIMENSIONS ARE IMPORTANT TO PATIENTS IN THEIR EXPERIENCE OF CONTINUITY OF CARE? A STUDY OF PATIENTS' PREFERENCES USING A DISCRETE CHOICE EXPERIMENT

Abstract Background Clinical uncertainty is inherent for people with frailty and multimorbidity. Depleted physiological reserves increase vulnerability to a decline in health and adverse outcomes from a stressor event. Evidence-based tools can improve care processes and outcomes, but little is known about priorities to deliver care for older people with frailty and multimorbidity. This study aimed to explore the preferences and priorities for patients, family carers and healthcare practitioners to enhance care processes of comprehensive assessment, communication and continuity of care in managing clinical uncertainty using evidence-based tools. Methods A parallel mixed method observational study in four inpatient intermediate care units (community hospitals) for patients in transition between hospital and home. We used a discrete choice experiment (DCE) to examine patient and family preferences and priorities on the attributes of enhanced services; and stakeholder consultations with practitioners to discuss and generate recommendations on using tools to augment care processes. Data analysis used logit modelling in the DCE, and framework analysis for consultation data. Results Thirty-three patients participated in the DCE (mean age 84 years, SD 7.76). Patients preferred a service where family were contacted on admission and discharge (β 0.36, 95% CI 0.10 to 0.61), care received closer to home (β − 0.04, 95% CI − 0.06 to − 0.02) and the GP is fully informed about care (β 0.29, 95% CI 0.05–0.52). Four stakeholder consultations (n = 48 participants) generated 20 recommendations centred around three main themes: tailoring care processes to manage multiple care needs for an ageing population with frailty and multimorbidity; the importance of ongoing communication with patient and family; and clear and concise evidence-based tools to enhance communication between clinical teams and continuity of care on discharge. Conclusion Family engagement is vital to manage clinical uncertainty. Both patients and practitioners prioritise engaging the family to support person-centred care and continuity of care within and across care settings. Patients wished to maximise family involvement by enabling their support with a preference for care close to home. Evidence-based tools used across disciplines and services can provide a shared succinct language to facilitate communication and continuity of care at points of transition in care settings.

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Comparing patients’ and other stakeholders’ preferences for outcomes of integrated care for multimorbidity: a discrete choice experiment in eight European countries

BMJ Open ◽

10.1136/bmjopen-2020-037547 ◽

2020 ◽

Vol 10 (10) ◽

pp. e037547

Author(s):

Maureen Rutten-van Mölken ◽

Milad Karimi ◽

Fenna Leijten ◽

Maaike Hoedemakers ◽

Willemijn Looman ◽

...

Keyword(s):

Integrated Care ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Continuity Of Care ◽

Physical Functioning ◽

Choice Experiment ◽

Well Being ◽

European Countries ◽

Stakeholder Groups ◽

Higher Weights

ObjectivesTo measure relative preferences for outcomes of integrated care of patients with multimorbidity from eight European countries and compare them to the preferences of other stakeholders within these countries.DesignA discrete choice experiment (DCE) was conducted in each country, asking respondents to choose between two integrated care programmes for persons with multimorbidity.SettingPreference data collected in Austria (AT), Croatia (HR), Germany (DE), Hungary (HU), the Netherlands (NL), Norway (NO), Spain (ES), and UK.ParticipantsPatients with multimorbidity, partners and other informal caregivers, professionals, payers and policymakers.Main outcome measuresPreferences of participants regarding outcomes of integrated care described as health/well-being, experience with care and cost outcomes, that is, physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person-centredness, continuity of care and total costs. Each outcome had three levels of performance.Results5122 respondents completed the DCE. In all countries, patients with multimorbidity, as well as most other stakeholder groups, assigned the (second) highest preference to enjoyment of life. The patients top-three most frequently included physical functioning, psychological well-being and continuity of care. Continuity of care also entered the top-three of professionals, payers and policymakers in four countries (AT, DE, HR and HU). Of the five stakeholder groups, preferences of professionals differed most often from preferences of patients. Professionals assigned lower weights to physical functioning in AT, DE, ES, NL and NO and higher weights to person-centredness in AT, DE, ES and HU. Payers and policymakers assigned higher weights than patients to costs, but these weights were relatively low.ConclusionThe well-being outcome enjoyment of life is the most important outcome of integrated care in multimorbidity. This calls for a greater involvement of social and mental care providers. The difference in opinion between patients and professionals calls for shared decision-making, whereby efforts to improve well-being and person-centredness should not divert attention from improving physical functioning.

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The essential ingredients of research supervision: A discrete-choice experiment.

Journal of Educational Psychology ◽

10.1037/edu0000322 ◽

2019 ◽

Vol 111 (7) ◽

pp. 1243-1260 ◽

Cited By ~ 3

Author(s):

Alex Roach ◽

Bruce K. Christensen ◽

Elizabeth Rieger

Keyword(s):

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Research Supervision

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INDIVIDUALS' PREFERENCES FOR ESOPHAGEAL CANCER SCREENING STRATEGIES: A DISCRETE CHOICE EXPERIMENT

10.1055/s-0039-1681488 ◽

2019 ◽

Author(s):

Y Peters ◽

E van Grinsven ◽

M van de Haterd ◽

D van Lankveld ◽

J Verbakel ◽

...

Keyword(s):

Esophageal Cancer ◽

Cancer Screening ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Screening Strategies

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A Note on Segmented Multinomial Logit Models for the Analysis of Discrete Choice Experiment Data

SSRN Electronic Journal ◽

10.2139/ssrn.3578105 ◽

2020 ◽

Author(s):

Henning Schaak

Keyword(s):

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Multinomial Logit ◽

Logit Models ◽

Experiment Data ◽

Multinomial Logit Models

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Preferences for antiviral therapy of chronic hepatitis C: a discrete choice experiment

The European Journal of Health Economics ◽

10.1007/s10198-016-0763-8 ◽

2016 ◽

Vol 18 (2) ◽

pp. 155-165 ◽

Cited By ~ 27

Author(s):

Axel C. Mühlbacher ◽

John F. P. Bridges ◽

Susanne Bethge ◽

Ch.-Markos Dintsios ◽

Anja Schwalm ◽

...

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Antiviral Therapy ◽

Chronic Hepatitis C ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment

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Patient preferences for specialist outpatient video consultations: A discrete choice experiment

Journal of Telemedicine and Telecare ◽

10.1177/1357633x211022898 ◽

2021 ◽

pp. 1357633X2110228

Author(s):

Centaine L Snoswell ◽

Anthony C Smith ◽

Matthew Page ◽

Liam J Caffery

Keyword(s):

General Practitioner ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Patient Preferences ◽

Choice Experiment ◽

Healthcare Delivery ◽

General Practitioner Practice ◽

Specialist Care ◽

Time Away ◽

Out Of Pocket Costs

Introduction Telehealth has been shown to improve access to care, reduce personal expenses and reduce the need for travel. Despite these benefits, patients may be less inclined to seek a telehealth service, if they consider it inferior to an in-person encounter. The aims of this study were to identify patient preferences for attributes of a healthcare service and to quantify the value of these attributes. Methods We surveyed patients who had taken an outpatient telehealth consult in the previous year using a survey that included a discrete choice experiment. We investigated patient preferences for attributes of healthcare delivery and their willingness to pay for out-of-pocket costs. Results Patients ( n = 62) preferred to have a consultation, regardless of type, than no consultation at all. Patients preferred healthcare services with lower out-of-pocket costs, higher levels of perceived benefit and less time away from usual activities ( p < 0.008). Most patients preferred specialist care over in-person general practitioner care. Their order of preference to obtain specialist care was a videoconsultation into the patient’s local general practitioner practice or hospital ( p < 0.003), a videoconsultation into the home, and finally travelling for in-person appointment. Patients were willing to pay out-of-pocket costs for attributes they valued: to be seen by a specialist over videoconference ($129) and to reduce time away from usual activities ($160). Conclusion Patients value specialist care, lower out-of-pocket costs and less time away from usual activities. Telehealth is more likely than in-person care to cater to these preferences in many instances.

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Understanding what women want: eliciting preference for delivery health facility in a rural subcounty in Kenya, a discrete choice experiment

BMJ Open ◽

10.1136/bmjopen-2020-038865 ◽

2020 ◽

Vol 10 (12) ◽

pp. e038865

Author(s):

Jackline Oluoch-Aridi ◽

Mary B Adam ◽

Francis Wafula ◽

Gilbert Kokwaro

Keyword(s):

Quality Of Care ◽

Health Facility ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Home Delivery ◽

Process Indicator ◽

Opt Out ◽

Women’S Preferences

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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