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Veneman T, Koopman FS, Oorschot S, Koomen PG, Nollet F, Voorn EL. A Mobile Health App to Support Home-Based Aerobic Exercise in Neuromuscular Diseases: Usability Study. JMIR Hum Factors 2024; 11:e49808. [PMID: 38488838 PMCID: PMC10980987 DOI: 10.2196/49808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/21/2023] [Accepted: 01/20/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Home-based aerobic exercise in people with neuromuscular diseases (NMDs) has benefits compared to exercise in the hospital or a rehabilitation center because traveling is often cumbersome due to mobility limitations, and societal costs are lower. Barriers to home-based aerobic exercise include reduced possibilities for monitoring and lack of motivation. To overcome these and other barriers, we developed a mobile health app: Keep on training with ReVi (hereafter referred to as ReVi). OBJECTIVE We aimed to determine the usability of the ReVi app. METHODS Patients followed a 4-month, polarized, home-based aerobic exercise program on a cycle or rowing ergometer, with 2 low-intensity sessions and 1 high-intensity session per week supported by the ReVi app. The app collected training data, including heart rate and ratings of perceived exertion, provided real-time feedback on reaching target intensity zones, and enabled monitoring via an online dashboard. Physiotherapists instructed patients on how to use the ReVi app and supervised them during their training program. Patients and physiotherapists separately evaluated usability with self-developed questionnaires, including 9 questions on a 5-point Likert scale, covering the usability elements efficiency, effectiveness, and satisfaction. RESULTS Twenty-nine ambulatory adult patients (n=19 women; mean age 50.4, SD 14.2 years) with 11 different slowly progressive NMDs participated. Both patients and physiotherapists (n=10) reported that the app, in terms of its efficiency, was easy to use and had a rapid learning curve. Sixteen patients (55%) experienced 1 or more technical issue(s) during the course of the exercise program. In the context of effectiveness, 23 patients (81%) indicated that the app motivated them to complete the program and that it helped them to exercise within the target intensity zones. Most patients (n=19, 70%) and physiotherapists (n=6, 60%) were satisfied with the use of the app. The median attendance rate was 88% (IQR 63%-98%), with 76% (IQR 69%-82%) of time spent within the target intensity zones. Four adverse events were reported, 3 of which were resolved without discontinuation of the exercise program. CONCLUSIONS The usability of the ReVi app was high, despite the technical issues that occurred. Further development of the app to resolve these issues is warranted before broader implementation into clinical practice.
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Affiliation(s)
- Tim Veneman
- Amsterdam University Medical Center location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands
| | - Fieke Sophia Koopman
- Amsterdam University Medical Center location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands
| | - Sander Oorschot
- Amsterdam University Medical Center location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands
| | - Pien G Koomen
- Amsterdam University Medical Center location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands
| | - Frans Nollet
- Amsterdam University Medical Center location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands
| | - Eric L Voorn
- Amsterdam University Medical Center location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands
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Hutchinson C, Khadka J, Crocker M, Lay K, Milte R, Whitehirst DG, Engel L, Ratcliffe J. Examining interrater agreement between self-report and proxy-report responses for the quality of life-aged care consumers (QOL-ACC) instrument. J Patient Rep Outcomes 2024; 8:28. [PMID: 38436803 PMCID: PMC10912388 DOI: 10.1186/s41687-024-00705-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/18/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Quality of life is an important quality indicator for health and aged care sectors. However, self-reporting of quality of life is not always possible given the relatively high prevalence of cognitive impairment amongst older people, hence proxy reporting is often utilised as the default option. Internationally, there is little evidence on the impact of proxy perspective on interrater agreement between self and proxy report. OBJECTIVES To assess the impacts of (i) cognition level and (ii) proxy perspective on interrater agreement using a utility instrument, the Quality of Life-Aged Care Consumers (QOL-ACC). METHODS A cross-sectional study was undertaken with aged care residents and family member proxies. Residents completed the self-report QOL-ACC, while proxies completed two proxy versions: proxy-proxy perspective (their own opinion), and proxy-person perspective (how they believe the resident would respond). Interrater agreement was assessed using quadratic weighted kappas for dimension-level data and concordance correlation coefficients and Bland-Altman plots for utility scores. RESULTS Sixty-three residents (22, no cognitive impairment; 41, mild-to-moderate cognitive impairment) and proxies participated. In the full sample and in the mild-to-moderate impairment group, the mean self-reported QOL-ACC utility score was significantly higher than the means reported by proxies, regardless of perspective (p < 0.01). Agreement with self-reported QOL-ACC utility scores was higher when proxies adopted a proxy-person perspective. CONCLUSION Regardless of cognition level and proxy perspective, proxies tend to rate quality of life lower than residents. Further research is needed to explore the impact of such divergences for quality assessment and economic evaluation in aged care.
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Affiliation(s)
- Claire Hutchinson
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia.
| | - Jyoti Khadka
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia
- ROSA, Adelaide, South Australia, Australia
| | - Matthew Crocker
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia
| | - Kiri Lay
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia
| | - Rachel Milte
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia
| | - David Gt Whitehirst
- Faculty of Health Sciences, Simon Fraser University, British Columbia, Burnaby, Canada
| | - Lidia Engel
- School of Public Health and Preventive Medicine, Monash University Health Economics Group, Monash University, Melbourne, VIC, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia
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Lay K, Crocker M, Engel L, Ratcliffe J, Charlton S, Hutchinson C. How do older adults receiving aged care services understand and respond to the EQ-5D-5L? A think-aloud study in residential care. Qual Life Res 2023; 32:3161-3170. [PMID: 37386266 PMCID: PMC10522713 DOI: 10.1007/s11136-023-03466-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE The EQ-5D-5L is a preference-based instrument for measuring and valuing health-related quality of life (HRQoL). The EQ-5D-5L has been used extensively in economic evaluation, including in aged care. However, older adults' understanding of the EQ-5D-5L has not been comprehensively investigated to date. This research aimed to assess older adults' understanding of the EQ-5D-5L using a think-aloud protocol with two cognition groups: no cognitive impairment and mild/moderate cognitive impairment. METHODS Participants' cognition was assessed using the Standardised Mini-Mental State Examination (SMMSE). Face-to face interviews were conducted with concurrent and retrospective think-aloud encouraged through verbal probing. Audio recordings were transcribed, and qualitative analysis, informed by the Tourangeau four-stage Response Model (comprehension, retrieval, decision process, response process) was conducted in NVivo. RESULTS In total, 46 older adults (age 65 +) were recruited from 10 residential care facilities across South Australia (n = 25 no cognitive impairment, n = 21 mild/moderate cognitive impairment). Comprehension, retrieval, judgement and response mapping issues were common across all cognition levels and EQ-5D-5L dimensions. The two dimensions resulting in the most response issues were usual activities and personal care. CONCLUSION Older adults may bring a different understanding to the EQ-5D-5L descriptive system than that expected given testing with general population samples. Dimension descriptors that are more relevant to this population may facilitate responses that better align with the underlying EQ-5D-5L concept model.
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Affiliation(s)
- Kiri Lay
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Matthew Crocker
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Lidia Engel
- Health Economics Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | | | - Claire Hutchinson
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
- Health Economics Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Ratcliffe J, Bourke S, Li J, Mulhern B, Hutchinson C, Khadka J, Milte R, Lancsar E. Valuing the Quality-of-Life Aged Care Consumers (QOL-ACC) Instrument for Quality Assessment and Economic Evaluation. PHARMACOECONOMICS 2022; 40:1069-1079. [PMID: 35922616 PMCID: PMC9550725 DOI: 10.1007/s40273-022-01158-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 05/19/2023]
Abstract
OBJECTIVE This paper reports on the valuation of the classification system for the Quality-of-Life Aged Care Consumers (QOL-ACC) instrument using a discrete choice experiment (DCE) with duration with a large sample of older people receiving aged care services. METHODS A DCE with 160 choice sets of two quality-of-life state-survival duration combinations blocked into 20 survey versions, with eight choice sets in each version, was designed and administered through an on-line survey to older Australians receiving aged care services in home and via interviewer facilitation with older people in residential aged care settings. Model specifications investigating preferences with respect to survival duration and interactions between QOL-ACC dimension levels were estimated. Utility weights were developed, with estimated coefficients transformed to the 0 (being dead) to 1 (full health) scale to generate a value set suitable for application in quality assessment and for the calculation of quality-adjusted life-years for use in economic evaluation. RESULTS In total, 953 older people completed the choice experiment with valid responses. The estimation results from econometric model specifications indicated that utility increased with survival duration and decreased according to quality-of-life impairment levels. An Australian value set (range - 0.56 to 1.00) was generated for the calculation of utilities for all QOL-ACC states. CONCLUSION The QOL-ACC is unique in its focus on measuring and valuing quality of life from the perspective of older people themselves, thereby ensuring that the preferences of aged care service users are the primary focus for quality assessment and economic evaluation.
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Affiliation(s)
- Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Bedford Park, SA, Australia.
| | - Siobhan Bourke
- Department of Health Services Research and Policy, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Jinhu Li
- Department of Health Services Research and Policy, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, NSW, Australia
| | - Claire Hutchinson
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Jyoti Khadka
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Emily Lancsar
- Department of Health Services Research and Policy, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
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Cleland J, Hutchinson C, McBain C, Walker R, Milte R, Khadka J, Ratcliffe J. Developing dimensions for a new preference-based quality of life instrument for older people receiving aged care services in the community. Qual Life Res 2021; 30:555-565. [PMID: 32989683 PMCID: PMC7886721 DOI: 10.1007/s11136-020-02649-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2020] [Indexed: 11/05/2022]
Abstract
PURPOSE To identify the salient quality of life characteristics relevant to older people in receipt of community aged care services in order to develop dimensions for a draft descriptive system for a new preference-based quality of life instrument. METHODS Forty-one in-depth semi-structured interviews were undertaken with older people (65 years and over) receiving community aged care services across three Australian states to explore quality of life characteristics of importance to them. The data were analysed using framework analysis to extract broader themes which were organised into a conceptual framework. The data were then summarised into a thematic chart to develop a framework matrix which was used to interpret and synthesise the data. Care was taken throughout to retain the language that older people had adopted during the interviews to ensure that appropriate language was used when identifying and developing the quality of life dimensions. RESULTS The analysis resulted in the identification of five salient quality of life dimensions: independence, social connections, emotional well-being, mobility, and activities. CONCLUSION This research finds that quality of life for older people accessing aged care services goes beyond health-related quality of life and incorporates broader aspects that transcend health. The findings represent the first stage in a multiphase project working in partnership with older people to develop a new preference-based instrument of quality of life for informing quality assessment and economic evaluation in community aged care. In future work, draft items will be developed from these dimensions and tested in face validity interviews before progressing to further psychometric testing.
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Affiliation(s)
- Jenny Cleland
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
| | - Claire Hutchinson
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Candice McBain
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ruth Walker
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Rachel Milte
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Jyoti Khadka
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Healthy Ageing Research Consortium, Registry of Older South Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Ratcliffe J, Cameron I, Lancsar E, Walker R, Milte R, Hutchinson CL, Swaffer K, Parker S. Developing a new quality of life instrument with older people for economic evaluation in aged care: study protocol. BMJ Open 2019; 9:e028647. [PMID: 31129602 PMCID: PMC6538028 DOI: 10.1136/bmjopen-2018-028647] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The ageing of the population represents a significant challenge for aged care in Australia and in many other countries internationally. In an environment of increasing resource constraints, new methods, techniques and evaluative frameworks are needed to support resource allocation decisions that maximise the quality of life and well-being of older people. Economic evaluation offers a rigorous, systematical and transparent framework for measuring quality and efficiency, but there is currently no composite mechanism for incorporating older people's values into the measurement and valuation of quality of life for quality assessment and economic evaluation. In addition, to date relatively few economic evaluations have been conducted in aged care despite the large potential benefits associated with their application in this sector. This study will generate a new preference based older person-specific quality of life instrument designed for application in economic evaluation and co-created from its inception with older people. METHODS AND ANALYSIS A candidate descriptive system for the new instrument will be developed by synthesising the findings from a series of in-depth qualitative interviews with 40 older people currently in receipt of aged care services about the salient factors which make up their quality of life. The candidate descriptive system will be tested for construct validity, practicality and reliability with a new independent sample of older people (n=100). Quality of life state valuation tasks using best worst scaling (a form of discrete choice experiment) will then be undertaken with a representative sample of older people currently receiving aged care services across five Australian states (n=500). A multinomial (conditional) logistical framework will be used to analyse responses and generate a scoring algorithm for the new preference-based instrument. ETHICS AND DISSEMINATION The new quality of life instrument will have wide potential applicability in assessing the cost effectiveness of new service innovations and for quality assessment across the spectrum of ageing and aged care. Results will be disseminated in ageing, quality of life research and health economics journals and through professional conferences and policy forums. This study has been reviewed by the Human Research Ethics Committee of the University of South Australia and has ethics approval (Application ID: 201644).
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Affiliation(s)
- Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Ian Cameron
- Rehabilitation Studies Unit, University of Sydney, Sydney, New South Wales, Australia
| | - Emily Lancsar
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ruth Walker
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Rachel Milte
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Claire Louise Hutchinson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Kate Swaffer
- Dementia Alliance International, Adelaide, South Australia, Australia
| | - Stuart Parker
- Institute of Health and Society/Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
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Cost-effectiveness of Balloon Kyphoplasty for Patients With Acute/Subacute Osteoporotic Vertebral Fractures in the Super-Aging Japanese Society. Spine (Phila Pa 1976) 2019; 44:E298-E305. [PMID: 30086080 DOI: 10.1097/brs.0000000000002829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A propensity score matching study. OBJECTIVE The aim of this study was to assess the cost-effectiveness of balloon kyphoplasty (BKP) in Japan. SUMMARY OF BACKGROUND DATA Osteoporotic vertebral fracture (OVF) is a common disease in elderly people. In Japan, the incidence of painful OVF in 2008 was estimated as 880,000, and approximately 40% of patients with painful OVF are hospitalized due to the severity of pain. Japan is the front runner among super-aged societies and rising health care costs are an economic problem. METHODS BKP and nonsurgical management (NSM) for acute/subacute OVF were performed in 116 and 420 cases, respectively. Quality-adjusted life years (QALY) and incremental costs were calculated on the basis of a propensity score matching study. QALY was evaluated using the SF-6D questionnaire. Finally, using a Markov model, incremental cost-effectiveness ratios (ICERs) were calculated for 71 matched cases. RESULTS In the comparison between BKP and NSM, mean patients age was 78.3 and 77.7 years, respectively (P = 0.456). The BKP procedure cost 402,988 JPY more than NSM and the gains in QALY at the 6-month follow-up were 0.153 and 0.120, respectively (difference = 0.033). ICERs for 3 and 20 years were 4,404,158 JPY and 2,416,406 JPY, respectively. According to sensitivity analysis, ICERs ranged from 652,181 JPY to 4,896,645 JPY (4418-33,168 GBP). CONCLUSION This study demonstrated that BKP is a cost-effective treatment option for OVF in Japan. However, the effect might be blunted in patients aged > 80 years. Further research is necessary to elucidate the cost-effectiveness of BKP in this population. LEVEL OF EVIDENCE 4.
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Bulamu NB, Kaambwa B, Ratcliffe J. Economic evaluations in community aged care: a systematic review. BMC Health Serv Res 2018; 18:967. [PMID: 30547788 PMCID: PMC6295002 DOI: 10.1186/s12913-018-3785-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 12/02/2018] [Indexed: 12/21/2022] Open
Abstract
Background This paper reports the methods and findings from a systematic review of economic evaluations conducted in the community aged care sector between 2000 and 2016. Methods Online databases searched were PubMed, Medline, Scopus, and web of science, CINAHL and informit. Studies were included if they 1) were full economic evaluations that compared both the costs and outcomes of two or more interventions 2) in study population of people aged 65 years and over 3) dependent older people living in the community 4) alternatives being compared were care models or service delivery interventions in the community aged care sector (a group of programs that have been established as a support system to allow older people to remain living in their own homes for as long as possible, as an alternative to institutional or residential care) and 5) published in the English language between 2000 and November 2016. Results Eleven studies reporting upon economic evaluations of service delivery interventions in community aged care were identified; the majority of which were undertaken in Europe. Critical appraisal of the identified studies highlighted the methodological rigour in these evaluations. Conclusion This systematic review highlights the paucity of economic evaluation studies conducted to date in the community aged care sector. The findings highlight the importance of cost utility analysis methodology as it allows for a uniform outcome measure, that facilitates the comparison of different interventions. In addition, multi-attribute utility measures that represent those quality of life domains that are most important to older people should be used and attention must be paid to the inclusion of informal care costs and outcomes as this is a key resource in community aged care service delivery.
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Affiliation(s)
- Norma B Bulamu
- Health Economics Unit, Flinders Health Care and Workforce Innovations, School of Medicine, Flinders University, Adelaide, SA, Australia.
| | - Billingsley Kaambwa
- Health Economics Unit, Flinders Health Care and Workforce Innovations, School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Julie Ratcliffe
- Institute for Choice, University of South Australia Business School, Adelaide, SA, Australia
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Milte R, Crotty M, Miller MD, Whitehead C, Ratcliffe J. Quality of life in older adults following a hip fracture: an empirical comparison of the ICECAP-O and the EQ-5D-3 L instruments. Health Qual Life Outcomes 2018; 16:173. [PMID: 30185193 PMCID: PMC6126006 DOI: 10.1186/s12955-018-1005-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/29/2018] [Indexed: 02/01/2023] Open
Abstract
Background The purpose of this study was to empirically compare the performance of two generic preference based quality of life instruments, EQ-5D-3 L (with a health and physical function focus) and ICECAP-O (with a wellbeing and capability focus), in a population of older Australians following hip fracture. Methods Older adults or their family member proxies (in cases of severe cognitive impairment) following surgery to repair a fractured hip were invited to take part in this cross sectional study. Inclusion criteria included an age of 60 years or older, confirmed falls-related hip fracture and those receiving current palliative care or consented to other research studies were excluded. 87 participants completed the ICECAP-O and EQ-5D-3 L instruments between one and three weeks post-surgery. Results For the hip fracture population, the mean ICECAP-O score was 0.639 (SD 0.206, n = 82) and the mean EQ-5D-3 L utility score was 0.545 (SD 0.251, n = 87). There was a statistically significant positive correlation between the ICECAP-O and EQ-5D-3 L scores (r = 0.529, p = < 0.001). Conclusions Study findings indicate significant impairments in quality of life post hip fracture. In multiple regression analyses, age and health-related QoL (measured by the EQ-5D) were significant determinants of ICECAP-O scores, while proxy respondent status, age, and capability-related QoL (measured by the ICECAP-O) were significant determinants of EQ-5D scores. Approaches to measuring and valuing quality of life in this sample, should consider the target domains of the intervention in their choice of instrument. Studies aiming to measure the impact of interventions targeting broader domains of wellbeing and QoL should consider including a broader measure of QoL in conjunction with a HRQoL measure.
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Affiliation(s)
- Rachel Milte
- Nutrition and Dietetics, Flinders University, Adelaide, SA, Australia. .,Institute for Choice, University of South Australia, GPO Box 2471, Adelaide SA, SA, 5001, Australia.
| | - Maria Crotty
- Rehabilitation, Aged, and Extended Care, Flinders University, Adelaide, SA, Australia
| | - Michelle D Miller
- Nutrition and Dietetics, Flinders University, Adelaide, SA, Australia
| | - Craig Whitehead
- Rehabilitation, Aged, and Extended Care, Flinders University, Adelaide, SA, Australia
| | - Julie Ratcliffe
- Institute for Choice, University of South Australia, GPO Box 2471, Adelaide SA, SA, 5001, Australia.,Flinders Clinical Effectiveness, Flinders University, Adelaide, SA, Australia
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Kaambwa B, Mpundu-Kaambwa C, Adams R, Appleton S, Martin S, Wittert G. Suitability of the Epworth Sleepiness Scale (ESS) for Economic Evaluation: An Assessment of Its Convergent and Discriminant Validity. Behav Sleep Med 2018; 16:448-470. [PMID: 27754703 DOI: 10.1080/15402002.2016.1228647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the suitability for use within economic evaluation of a widely used sleep-related instrument (the Epworth Sleepiness Scale [ESS]) by examining its convergent and discriminant validity with two widely used generic preference-based instruments (Short-Form 36 [SF-36] and the Assessment of Quality of Life 4 dimensions [AQoL-4D]). METHODS Data from a cross-section of 2,236 community-dwelling Australian men were analyzed. Convergent validity was investigated using Spearman's correlation, intraclass correlation, and modified Bland-Altman plots, while discriminant validity was examined using Kruskal Wallis tests. RESULTS All instruments showed good discriminant validity. The ESS was weakly correlated to the Short Form 6 dimension, or SF-6D (derived from the SF-36) and AQoL-4D utilities (r = 0.20 and r = 0.19, respectively). Correlations between ESS and SF-36/AQoL-4D dimensions measuring the same construct were all in the hypothesized directions but also weak (range of absolute r = 0.00 to 0.18). The level of agreement between the ESS and AQoL-4D was the weakest, followed by that between the ESS and SF-6D. Moderate convergent validity was seen between the utilities. CONCLUSIONS The lack of convergent validity between the ESS and the preference-based instruments shows that sleep-related constructs are not captured by the latter. The ESS has, however, demonstrated good discriminant validity comparable to that of the AQoL-4D and the SF-36/SF-6D and would therefore be equally useful for measuring subgroup differences within economic evaluation. We therefore recommend using the ESS within cost-effectiveness analysis as a complement to preference-based instruments in order to capture sleep-specific constructs not measured by the latter.
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Affiliation(s)
- Billingsley Kaambwa
- a Health Economics Unit, School of Medicine, Flinders University , Adelaide , Australia
| | | | - Robert Adams
- b The Health Observatory, Discipline of Medicine, University of Adelaide , Adelaide , Australia
| | - Sarah Appleton
- b The Health Observatory, Discipline of Medicine, University of Adelaide , Adelaide , Australia
| | - Sean Martin
- c Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide , Adelaide , Australia
| | - Gary Wittert
- c Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide , Adelaide , Australia
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Milte R, Ratcliffe J, Chen G, Crotty M. What Characteristics of Nursing Homes Are Most Valued by Consumers? A Discrete Choice Experiment with Residents and Family Members. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:843-849. [PMID: 30005757 DOI: 10.1016/j.jval.2017.11.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 11/01/2017] [Accepted: 11/04/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To generate a scoring algorithm weighted on the preferences of consumers for assessing the quality of care in nursing homes (i.e., aged care homes or institutions) in six key domains. METHODS A discrete choice experiment was undertaken with residents of nursing homes (n = 126) or family member proxies (n = 416) in cases where severe cognitive impairment precluded resident participation. Analysis was undertaken using conditional and mixed logit regression models to determine preferences for potential attributes. RESULTS The findings indicate that all six attributes investigated were statistically significant factors for participants. Feeling at home in the resident's own room was the most important characteristic to both residents and family members. Care staff being able to spend enough time with residents, feeling at home in shared spaces, and staff being very flexible in care routines were also characteristics identified as important for both groups. The results of the Swait-Louviere test rejected the null hypothesis that the estimated parameters between residents and family members were the same, indicating that data from these two groups could not be pooled to generate a single weighted scoring algorithm for the Consumer Choice Index-Six Dimension instrument. Preferences were therefore encapsulated to generate scoring algorithms specific to residents and family members. CONCLUSIONS This study provides important insights into the characteristics of nursing home care that are most valued by consumers. The Consumer Choice Index-Six Dimension instrument may be usefully applied in the evaluation, planning, and design of future services.
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Affiliation(s)
- Rachel Milte
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia; Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia; Institute for Choice, University of South Australia, Adelaide, South Australia, Australia.
| | - Julie Ratcliffe
- Institute for Choice, University of South Australia, Adelaide, South Australia, Australia; Flinders Health Economics Group, Flinders University, Adelaide, South Australia, Australia
| | - Gang Chen
- Flinders Health Economics Group, Flinders University, Adelaide, South Australia, Australia; Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia; Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia
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Milte R, Ratcliffe J, Chen G, Miller M, Crotty M. Taste, choice and timing: Investigating resident and carer preferences for meals in aged care homes. Nurs Health Sci 2018; 20:116-124. [PMID: 29314590 PMCID: PMC6635740 DOI: 10.1111/nhs.12394] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 09/16/2017] [Accepted: 09/18/2017] [Indexed: 01/09/2023]
Abstract
There has been little empirical investigation of the preferences of people living in aged care homes for food services. The aim of the present study was to elicit consumer preferences and their willingness to pay for food service in aged care homes. Current residents or their family members were invited to take part in the discrete choice experiment questionnaire administered via interview. Of the 109 eligible residents and 175 eligible family members approached for consent 121 (43%) participated, including 43 residents. Participant preferences were influenced by food taste, choice in relation to serving size, timing of meal selection, visual appeal, and additional cost. Participants indicated they would be willing to pay an additional $24 (US$18.42) per week for food which tasted excellent and $8 (US$6.14) per week to have choice in serving sizes. The study found that respondents were willing to pay a premium to receive food that met their expectations of taste, and for a high level of control over serving sizes, which has implications for the funding and provision of food and dining in long-term care in the future.
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Affiliation(s)
- Rachel Milte
- Department of Rehabilitation, Aged and Extended CareFlinders UniversityAdelaideSouth AustraliaAustralia
- National Health and Medical Research CouncilCognitive Decline Partnership CentreSydneyNew South WalesAustralia
- Institute for ChoiceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Julie Ratcliffe
- Institute for ChoiceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
- Flinders Health Economics GroupFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Gang Chen
- Flinders Health Economics GroupFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Michelle Miller
- Department of Nutrition and DieteticsFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended CareFlinders UniversityAdelaideSouth AustraliaAustralia
- National Health and Medical Research CouncilCognitive Decline Partnership CentreSydneyNew South WalesAustralia
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Older People’s Preferences for Side Effects Associated with Antimuscarinic Treatments of Overactive Bladder: A Discrete-Choice Experiment. Drugs Aging 2017; 34:615-623. [DOI: 10.1007/s40266-017-0474-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
ABSTRACTAustralian providers of aged care are facing a rapidly ageing population and growth in demand for services. Beyond a sheer increase in consumers and major regulatory changes from Federal Government, many customers are becoming progressively discontented with a medically dominated model of care provision. This period of turbulence presents an opportunity for new entrants and forward-thinking organisations to disrupt the market by designing a more compelling value offering. Under this line of inquiry, the researchers conducted a qualitative content analysis study of over 37 Australian aged care organisations, clustering providers into six business model typologies. The study revealed that providers of aged care are becoming increasingly aware of emerging customer needs, and, in addressing these needs, are seeking to establish innovative models of care provision. This paper therefore presents a future model of care, along with implications for practice and policy.
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An empirical comparison of the OPQoL-Brief, EQ-5D-3 L and ASCOT in a community dwelling population of older people. Health Qual Life Outcomes 2015; 13:164. [PMID: 26420314 PMCID: PMC4588872 DOI: 10.1186/s12955-015-0357-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/18/2015] [Indexed: 11/21/2022] Open
Abstract
Background This study examined the relationships between a newly developed older person-specific non-preference-based quality of life (QoL) instrument (Older People’s Quality of Life brief questionnaire (OPQoL-brief)) and two generic preference-based instruments (the EQ-5D-3L Level (EQ-5D-3 L) and the Adult Social Care Outcomes Toolkit (ASCOT) in a community-dwelling population of Australian older people receiving aged care services. Methods We formulated hypotheses about the convergent validity between the instruments (examined by Wilcoxon-Mann Whitney, Kruskal Wallis and Spearman’s correlation tests) and levels of agreement (assessed using intra class correlation (ICC) and modified Bland-Altman plots based on normalized Z EQ-5D-3 L and ASCOT utilities and OPQoL-Brief summary scores). Results The utilities/summary scores for 87 participants (aged 65–93 years) were moderately but positively correlated. Moderate convergent validity was evident for a number of instrument dimensions with the strongest relationship (r = 0.57) between ‘enjoy life’ (OPQoL-Brief) and ‘social contact’ (ASCOT). The overall ICC was 0.54 and Bland-Altman scatter plots showed 3–6 % of normalized Z-scores were outside the 95 % limits of agreement suggesting moderate agreement between all three instruments (agreement highest between the OPQoL-Brief and the ASCOT). Conclusions Our results suggest that the OPQoL-Brief, the ASCOT and the EQ-5D_3L are suitable for measuring quality of life outcomes in community-dwelling populations of older people. Given the different constructs underpinning these instruments, we recommend that choice of instrument should be guided by the context in which the instruments are being applied. Currently, the OPQoL-Brief is not suitable for use in cost-utility analyses as it is not preference-based. Given their different perspectives, we recommend that both the ASCOT and the EQ-5D are applied simultaneously to capture broader aspects of quality of life and health status within cost-utility analyses within the aged care sector. Future research directed towards the development of a new single preference-based instrument that incorporates both health status and broader aspects of quality of life within quality adjusted life year calculations for older people would be beneficial.
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Aguirre E, Kang S, Hoare Z, Edwards RT, Orrell M. How does the EQ-5D perform when measuring quality of life in dementia against two other dementia-specific outcome measures? Qual Life Res 2015; 25:45-9. [PMID: 26163146 DOI: 10.1007/s11136-015-1065-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE This study aimed to assess and compare the psychometric performance of the EQ-5D in relation to other dementia-specific measures, the QoL-AD and DEMQoL, within a psychosocial intervention study. METHODS Two hundred and seventy-two people with dementia completed the EQ-5D, DEMQoL and QoL-AD. Convergent and discriminant validity of the measures were assessed, and inter-rater reliability was tested by comparing the self-reported and proxy scores of the measures. Internal consistency was tested using Cronbach's alpha. RESULTS Results satisfy convergent validity amongst the three outcome measures. EQ-5D, DEMQoL and QoL-AD total scores were shown to be significantly correlated with each other (p < 0.001) in both participants with dementia and proxy reports. Results also satisfied discriminant validity for participant EQ-5D, DEMQoL and QoL-AD total scores. In relation to reliability between self and proxy scores, the EQ-5D showed higher reliability scores between participant and proxy total scores for mild and moderate level of cognitive impairment and performed better than the dementia-specific measures. Reliability assessed through Cronbach's alpha was satisfactory, indicating adequate internal consistency of all three measures. CONCLUSIONS The results suggest that the EQ-5D might have advantages over other dementia-specific measures, and it could be used routinely and as a stand-alone measure of quality of life in dementia research.
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Affiliation(s)
- Elisa Aguirre
- Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, England, UK.
| | - Sujin Kang
- Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, England, UK.
| | - Zoe Hoare
- Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, England, UK.
| | - Rhiannon Tudor Edwards
- Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, England, UK.
| | - Martin Orrell
- Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EJ, England, UK.
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Wong FKY, So C, Chau J, Law AKP, Tam SKF, McGhee S. Economic evaluation of the differential benefits of home visits with telephone calls and telephone calls only in transitional discharge support. Age Ageing 2015; 44:143-7. [PMID: 25355620 PMCID: PMC4255617 DOI: 10.1093/ageing/afu166] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: home visits and telephone calls are two often used approaches in transitional care, but their differential economic effects are unknown. Objective: to examine the differential economic benefits of home visits with telephone calls and telephone calls only in transitional discharge support. Design: cost-effectiveness analysis conducted alongside a randomised controlled trial (RCT). Participants: patients discharged from medical units randomly assigned to control (control, N = 210), home visits with calls (home, N = 196) and calls only (call, N = 204). Methods: cost-effectiveness analyses were conducted from the societal perspective comparing monetary benefits and quality-adjusted life years (QALYs) gained. Results: the home arm was less costly but less effective at 28 days and was dominating (less costly and more effective) at 84 days. The call arm was dominating at both 28 and 84 days. The incremental QALY for the home arm was −0.0002/0.0008 (28/84 days), and the call arm was 0.0022/0.0104 (28/84 days). When the three groups were compared, the call arm had a higher probability being cost-effective at 84 days but not at 28 days (home: 53%, call: 35% (28 days) versus home: 22%, call: 73% (84 days)) measuring against the NICE threshold of £20,000. Conclusion: the original RCT showed that the bundled intervention involving home visits and calls was more effective than calls only in the reduction of hospital readmissions. This study adds a cost perspective to inform policymakers that both home visits and calls only are cost-effective for transitional care support, but calls only have a higher chance of being cost-effective for a sustained period after intervention.
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Affiliation(s)
- Frances Kam Yuet Wong
- School of Nursing, The Hong Kong Polytechnic University, Hunghom, Kowloon, Hong Kong, China
| | - Ching So
- Department of Community Medicine, School of Public Health, University of Hong Kong, Hong Kong, China
| | - June Chau
- Department of Community Medicine, School of Public Health, University of Hong Kong, Hong Kong, China
| | - Antony Kwan Pui Law
- School of Nursing, The Hong Kong Polytechnic University, Hunghom, Kowloon, Hong Kong, China
| | - Stanley Ku Fu Tam
- Department of Medicine, Queen Elizabeth Hospital/Hong Kong Buddhist Hospital, Hong Kong, China
| | - Sarah McGhee
- Department of Community Medicine, School of Public Health, University of Hong Kong, Hong Kong, China
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Milte CM, Walker R, Luszcz MA, Lancsar E, Kaambwa B, Ratcliffe J. How important is health status in defining quality of life for older people? An exploratory study of the views of older South Australians. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2014; 12:73-84. [PMID: 24254996 DOI: 10.1007/s40258-013-0068-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Cost-effectiveness analyses of interventions for older adults have traditionally focused on health status. However, there is increasing recognition of the need to develop new instruments to capture quality of life in a broader sense in the face of age-associated increasing frailty and declining health status, particularly in the economic evaluation of aged and social care interventions that may have positive benefits beyond health. OBJECTIVE To explore the relative importance of health and broader quality of life domains for defining quality of life from the perspective of older South Australians. METHODS Older adults (n=21) from a day rehabilitation facility in Southern Adelaide, South Australia attended one of two audio-recorded focus groups. A mixed methods (qualitative and quantitative) study design was adopted. The study included three main components. First was a general group discussion on quality of life and the factors of importance in defining quality of life. Second was a structured ranking exercise in which individuals were asked to rank domains from the brief Older People's Quality of Life (OPQOL-brief) questionnaire and Adult Social Care Outcomes Toolkit (ASCOT) in order of importance. Third, participants were asked to self-complete the EuroQol five-dimension (EQ-5D), a measure of health status, and two broader quality-of-life measures: the OPQOL-brief and ASCOT. RESULTS Mean scores on the EQ-5D, OPQOL-brief and ASCOT were 0.71 (standard deviation [SD] 0.20, range 0.06-1.00), 54.6 (SD 5.5, range 38-61) and 0.87 (SD 0.13, range 0.59-1.00), respectively, with higher scores reflecting better ratings. EQ-5D scores were positively associated with OPQOL-brief (Spearman's Rho: 0.730; p<0.01), but not ASCOT. Approximately half (52.4%) of the participants ranked either 'health' or 'psychological and emotional well-being' as the domain most important to their quality of life. However, one-third (33.3%) of the total sample ranked a non-health domain from the ASCOT or OPQOL-brief (safety, dignity, independence) as the most important contributing factor to their overall quality of life. Qualitative analysis of focus group transcripts supported the high value of both health-related (health, psychological well-being) and social (independence, safety) domains to quality of life. CONCLUSIONS Older adults value both health and social domains as important to their overall quality of life. Future economic evaluations of health, community and aged-care services for older adults should include assessment of both health-related and broader aspects of quality of life.
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Affiliation(s)
- Catherine M Milte
- Flinders University Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daws Road, Daw Park, SA, 5051, Australia
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Couzner L, Crotty M, Walker R, Ratcliffe J. Examining older patient preferences for quality of care in postacute transition care and day rehabilitation programs. Health (London) 2013. [DOI: 10.4236/health.2013.56a2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Laver K, Ratcliffe J, George S, Lester L, Crotty M. Preferences for rehabilitation service delivery: A comparison of the views of patients, occupational therapists and other rehabilitation clinicians using a discrete choice experiment. Aust Occup Ther J 2012; 60:93-100. [DOI: 10.1111/1440-1630.12018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Kate Laver
- Department of Rehabilitation and Aged Care; Flinders University; Adelaide; South Australia; Australia
| | - Julie Ratcliffe
- Department of Rehabilitation and Aged Care; Flinders University; Adelaide; South Australia; Australia
| | - Stacey George
- Department of Rehabilitation and Aged Care; Flinders University; Adelaide; South Australia; Australia
| | - Laurence Lester
- Adelaide University Centre for Housing, Urban and Regional; Adelaide; South Australia; Australia
| | - Maria Crotty
- Department of Rehabilitation and Aged Care; Flinders University; Adelaide; South Australia; Australia
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Sheehan BD, Lall R, Stinton C, Mitchell K, Gage H, Holland C, Katz J. Patient and proxy measurement of quality of life among general hospital in-patients with dementia. Aging Ment Health 2012; 16:603-7. [PMID: 22360734 DOI: 10.1080/13607863.2011.653955] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND We aimed to investigate quality of life ratings among people with varying severity of dementia and their carers, recruited in general hospital. METHOD We recruited 109 people with dementia, and their proxies (carers), from psychiatric referrals of inpatients in two general hospitals in England. From patients, we gathered data on quality of life (QoL-AD and EQ5-D) and depressive symptoms, and from proxies we gathered data on patient quality of life (Proxy QoL-AD and EQ5-D), severity of dementia, activities of daily living, physical illness and depressive symptoms, and on carer stress. RESULTS Completion rates for both measures were progressively lower with increasing dementia severity. Patients rated their quality of life more highly than proxies on Qol-AD (patients=32.2, CI=30.7-33.7, proxies=24.7, CI=23.8-26.0, p<0.001) and on EQ5D (patients=0.71, CI=0.64-0.77, proxies=0.30, CI=0.22-0.38, p<0.001). For proxy EQ5D, impaired instrumental ADLs (p=0.003) and more severe dementia (p=0.019) were associated with ratings, while for proxy QoL-AD, only more severe dementia (p=0.039) was associated with ratings. Lower patient EQ-5D scores were independently associated only with carer stress (p=0.01). Lower patient QoL-AD scores were associated with patient depression (p=0.001), impaired activities of daily living (p=0.02) and proxy psychiatric symptoms (p=0.002). CONCLUSIONS Among patients with moderate to severe dementia in general hospital, proxy measures of quality of life are the only practical option. Patients and proxies appear to have very different concepts of quality of life in dementia.
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Howard K, Arendts G, Jan S, Beck M. PROSpER: PReferences for the Organisation of acute health Services for oldER people: protocol for a mixed methods study. BMJ Open 2012; 2:e001081. [PMID: 22466038 PMCID: PMC3317141 DOI: 10.1136/bmjopen-2012-001081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Organisation of acute care services for people living in residential aged care facilities (RACF) is a complex area of health policy. For people living in RACF, the emergency department is often used to provide acute care; needs of RACF residents, however, are not always well met. Alternative models of delivering care must be acceptable to a variety of stakeholders; however, little is known about the values and preferences that people attach to aspects of how and where care is delivered. METHODS/DESIGN The PROSpER Study examines people's preferences for the organisation of acute healthcare services for older people in RACF. The authors aim to (1) determine which factors influence preferences of residents, carers and providers for how and where acute care is delivered and (2) determine the relative importance of these factors and the acceptable trade-offs between them. Qualitative and quantitative methods will be used. One-on-one interviews will be conducted with RACF residents, their families, staff of RACF and emergency department staff. A discrete choice study will then be designed to quantitatively assess preferences for alternative models of care delivery. Approximately 600 respondents from three respondent groups will be surveyed: older people living in RACF, family members of aged care residents and staff of RACF. A mixed logit model will be used; results will be expressed as parameter estimates (β) and odds of choosing one option over an alternative. Trade-offs between attributes will also be calculated. ETHICS AND DISSEMINATION The PROSpER Study has been approved by the University of Sydney, Human Research Ethics Committee (Protocol numbers 10653 and 14382) and Royal Perth Hospital Ethics Committee (reference 2009/045). Results will be published in peer-reviewed scientific journals and via conference presentations; a newsletter will also be provided to study participants. A stakeholder roundtable will also be held to discuss the results.
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Affiliation(s)
- Kirsten Howard
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Glenn Arendts
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Centre for Clinical Research in Emergency Medicine, Western Australian Institute for Medical Research, Perth, Western Australia, Australia
- School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, Western Australia, Australia
| | - Stephen Jan
- The George Institute for Global Health, Camperdown, New South Wales, Australia
| | - Matthew Beck
- Institute for Transport and Logistics Studies, University of Sydney, Sydney, New South Wales, Australia
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Tao P, Lin MH, Peng LN, Lee WC, Lin FY, Lee CH, Chien CW, Shen V, Chen LK. Reducing the burden of morbidity and medical utilization of older patients by outpatient geriatric services: Implications to primary health-care settings. Geriatr Gerontol Int 2012; 12:612-21. [DOI: 10.1111/j.1447-0594.2011.00823.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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