Efficiency Gains Afforded by Improved Bid Design versus Follow-up Valuation Questions in Discrete-Choice CV Studies

Abstract Background The current health care system is challenged with a large and rising demand for obstructive sleep apnoea (OSA) services. A paradigm shift in OSA management is required to incorporate the preferences of diagnosed patients and individuals at high-risk of OSA. This study aimed to provide empirical evidence of the values and preferences of individuals diagnosed with OSA and high-risk populations regarding distinct OSA care pathway features. Methods A discrete choice experiment (DCE) was undertaken in two groups: those with a formal diagnosis of OSA (n=421) and those undiagnosed but at high-risk of having OSA (n=1033). The DCE approach used mixed logit regression models to determine preferences relating to eight salient features of OSA management pathway, i.e. initial assessment, setting and diagnosis costs, waiting times, results interpretation, treatment options, provider of ongoing care and frequency of follow up visits. Results The findings indicate that all eight attributes investigated were statistically significant factors for respondents. Generally, both groups preferred low diagnostic costs, fewer follow-up visits, minimum waiting time for sleep study results, and sleep specialists to recommend treatment and as ongoing care providers. Management of OSA in primary care was acceptable to both groups and was the most preferred option by the high-risk group for sleep study testing and ongoing care provision. Discussion The DCE results offer a promising approach for systematic incorporation of patient and high-risk groups preferences into the future design and delivery of care pathways for OSA management.

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Preference for Telehealth Sustained Over Three Months at an Outpatient Center for Integrative Medicine

Global Advances in Health and Medicine ◽

10.1177/2164956121997361 ◽

2021 ◽

Vol 10 ◽

pp. 216495612199736

Author(s):

Michael T. M. Finn ◽

Hannah R. Brown ◽

Emily R. Friedman ◽

A. Grace Kelly ◽

Kathryn Hansen

Keyword(s):

Integrative Medicine ◽

Discrete Choice ◽

Mixed Method ◽

Southeastern United States ◽

Chronic Medical Conditions ◽

Administrative Staff ◽

Outpatient Center ◽

Rapid Transition ◽

Chronic Pain Conditions

Background Integrative medicine is a key framework for the treatment of chronic medical conditions, particularly chronic pain conditions. The COVID-19 pandemic prompted rapid implementation of telehealth services. Objective We present outcomes of a complete and rapid transition to telehealth visits at an outpatient integrative medicine center in the Southeastern United States. Method Patients and administrative staff took surveys comparing telehealth to in-person visits within four weeks of our clinic's transition to telehealth and three months later. Beginning four weeks after the clinic’s telehealth conversion in March 2020, patients who had a telehealth visit at the center completed a survey about their telehealth experience and another survey three months later. Results Patient quality judgements significantly favored telehealth at baseline, B = .77 [0.29 – 1.25], SE = .25, t(712) = 3.15, p = .002, and increased at three months, B = .27 [–0.03 – 0.57], SE = .15, t(712) = 1.76, p = .079. Telehealth technology usability and distance from the center predicted patient ratings of telehealth favorability. Providers favored in-person visits more than patients, B = –1.00 [–1.56 – –0.44], SE = .29, t(799) = –3.48, p < .001, though did not favor either in-person or telehealth more than the other. Patient discrete choice between telehealth and in-person visits was split at baseline (in-person: n = 86 [54%]; telehealth: n = 73 [46%]), but favored telehealth at three months (in-person: n = 17 [40%]; telehealth: n = 26 [60%]). Overall, discrete choice favored telehealth at follow-up across providers and patients, OR = 2.69 [.1.18 – 6.14], z = 2.36, p = .018. Major qualitative themes highlight telehealth as acceptable and convenient, with some challenges including technological issues. Some felt a loss of interpersonal connection during telehealth visits, while others felt the opposite. Conclusion We report converging mixed-method data on the successful and sustained implementation of telehealth with associated policy and clinical implications during and beyond the COVID-19 pandemic.

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Eliciting Preferences of Providers in Primary Care Settings for Post Hospital Discharge Patient Follow-Up

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18168317 ◽

2021 ◽

Vol 18 (16) ◽

pp. 8317

Author(s):

Xin Wang ◽

Kuimeng Song ◽

Lijin Chen ◽

Yixiang Huang ◽

Stephen Birch

Keyword(s):

Primary Care ◽

Hospital Discharge ◽

Discrete Choice ◽

Choice Experiment ◽

Primary Care Providers ◽

Care Providers ◽

Post Discharge ◽

Primary Care Settings ◽

Follow Up Care

Background: Post-hospital discharge follow-up has been a principal intervention in addressing gaps in care pathways. However, evidence about the willingness of primary care providers to deliver post-discharge follow-up care is lacking. This study aims to assess primary care providers’ preferences for delivering post-discharge follow-up care for patients with chronic diseases. Methods: An online questionnaire survey of 623 primary care providers who work in a hospital group of southeast China. Face-to-face interviews with 16 of the participants. A discrete choice experiment was developed to elicit preferences of primary care providers for post-hospital discharge patient follow-up based on six attributes: team composition, workload, visit pattern, adherence of patients, incentive mechanism, and payment. A conditional logit model was used to estimate preferences, willingness-to-pay was modelled, a covariate-adjusted analysis was conducted to identify characteristics related to preferences, 16 interviews were conducted to explore reasons for participants’ choices. Results: 623 participants completed the discrete choice experiment (response rate 86.4%, aged 33 years on average, 69.5% female). Composition of the follow-up team and adherence of patients were the attributes of greatest relative importance with workload and incentives being less important. Participants were indifferent to follow-up provided by home visit or as an outpatient visit. Conclusion: Primary care providers placed the most importance on the multidisciplinary composition of the follow-up team. The preference heterogeneity observed among primary care providers suggests personalized management is important in the multidisciplinary teams, especially for those providers with relatively low educational attainment and less work experience. Future research and policies should work towards innovations to improve patients’ engagement in primary care settings.

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What do patients and dermatologists prefer regarding low-risk basal cell carcinoma follow-up care? A discrete choice experiment

PLoS ONE ◽

10.1371/journal.pone.0249298 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0249298

Author(s):

Sven van Egmond ◽

Esther de Vries ◽

Loes Hollestein ◽

Maarten Bastiaens ◽

Kees-Peter de Roos ◽

...

Keyword(s):

Basal Cell Carcinoma ◽

Cell Carcinoma ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Basal Cell ◽

Choice Experiment ◽

Latent Class ◽

Low Risk ◽

Follow Up Care

Background Follow-up after low-risk basal cell carcinoma (BCC) is being provided more frequently than recommended by guidelines. To design an acceptable strategy to successfully reduce this ‘low-value’ care, it is important to obtain insights into the preferences of patients and dermatologists. Objective To determine the preferences and needs of patients and dermatologists to reduce low-risk BCC follow-up care, and the trade-offs they are willing to make. Methods A questionnaire including a discrete choice experiment was created, containing attributes regarding amount of follow-up, continuity of care, method of providing addition information, type of healthcare provider, duration of follow-up visits and skin examination. In total, 371 BCC patients and all Dutch dermatologists and dermatology residents (n = 620) were invited to complete the questionnaire. A panel latent class model was used for analysis. Results Eighty-four dermatologists and 266 BCC patients (21% and 72% response rates respectively) completed the discrete choice experiment. If the post-treatment visit was performed by the same person as treatment provider and a hand-out was provided to patients containing personalised information, the acceptance of having no additional follow-up visits (i.e. following the guidelines) would increase from 55% to 77% by patients. Female patients and older dermatologists, however, are less willing to accept the guidelines and prefer additional follow-up visits. Limitations The low response rate of dermatologists. Conclusion This discrete choice experiment revealed a feasible strategy to substantially reduce costs, while maintaining quality of care, based on the preferences and needs of BCC patients, which is supported by dermatologists.

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Preferences of gastric cancer survivors for follow-up care—a multicenter discrete choice experiment study

Supportive Care in Cancer ◽

10.1007/s00520-021-06505-1 ◽

2021 ◽

Author(s):

Hui-qin Li ◽

Hua Yuan ◽

Guang-ying Wan ◽

Hui Xue ◽

Xiu-ying Zhang

Keyword(s):

Gastric Cancer ◽

Cancer Survivors ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Experiment Study ◽

Follow Up Care

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Using a Discrete Choice Experiment to Examine the Factors Influencing Clinical Trial Participation in a Nationally Representative Sample

10.21203/rs.3.rs-498686/v1 ◽

2021 ◽

Author(s):

Michelle Queally ◽

Declan Devane ◽

Matthew D. Griffin ◽

Paddy Gillespie ◽

Abhay Pandit

Keyword(s):

Clinical Trial ◽

Side Effects ◽

Discrete Choice ◽

Choice Experiment ◽

Financial Incentive ◽

Relative Importance ◽

Factors Influencing ◽

Trade Offs ◽

Nationally Representative

Abstract IntroductionUnderstanding the key factors that inform an individual’s decision-making process for participating in a clinical trial (CT) can improve the efficiency of recruitment for CT studies. Currently, little is known, in quantitative terms, about the relative importance of the different factors that influence CT participation decisions.ObjectiveThe objectives of this study were to design and conduct a discrete choice experiment (DCE) to identify critical factors, or attributes, that influence CT participation, and to estimate public preferences for, and trade-offs between, different levels of these attributes.MethodsA DCE was designed, with input from a public patient involvement (PPI) panel and conducted via an online survey of 525 nationally representative Irish citizens. The attributes identified and included in the DCE to inform CT participation included: (1) communication, (2) financial incentive, (3) likelihood of benefit, (4) risk of side effects, and (5) follow up period. All respondents were presented with a set of choice cards and asked to choose between participating in one of two CTs, differentiated by their attributes levels, or opt-out. A series of econometric statistical regression models were estimated to generate the results of interest.ResultsRespondents had preferences which, in order of relative importance, had a lower risk of side effects, a higher likelihood of benefit, a shorter follow up, information communicated by the respondent’s doctor or nurse, and a financial incentive for participation.ConclusionTo the best of our knowledge, this is the first study to utilise a DCE to estimate preferences of the public regarding factors influencing CT participation. These findings may be useful for future CT design as they enable researchers to elicit how individuals may weigh up their choices and consider trade-offs between factors that affect their decision to participate. This study was also the first DCE to include a PPI panel to help inform the DCE design and development.

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