Using discrete choice experiment to elicit doctors' preferences for the report card design of diabetes care in Taiwan - a pilot study

Does public report card matter? A 10-year interrupted time series analysis on total knee replacement

BACKGROUND

There is a lack of evidence that shows whether a report card can improve health outcomes in terms of infection rates or unscheduled readmission by using rigorous methods to evaluate its impact.

METHODS

We used the National Health Insurance Administration's claims database from 1 January 2004 to 30 December 2013 and a time series analysis to evaluate the impact of the quality report card initiative on three negative outcomes of total knee replacement for each quarter of the year, including the rates of superficial infection of a knee replacement, deep infection of knee arthroplasty and unplanned readmissions for surgical site infection.

RESULTS

These negative outcomes (original scale) do not show significant decreases in terms of superficial infection (-0.05‰, -0.63 to 0.53‰, P = 0.87), deep infection (-0.003‰, -0.19 to 0.18‰, P = 0.97) and unscheduled readmission (0.02‰, -0.21 to 0.25‰, P = 0.88).

CONCLUSION

The total knee replacement public report card initiative did not improve the rate of infection and unscheduled readmission for surgical site infection. This report card in Taiwan should involve physicians' participation in the design and be tailored to be suitable for reading by patients in order to further enhance the chance of improvement in these negative outcomes.

Systematic review and validity assessment of methods used in discrete choice experiments of primary healthcare professionals

INTRODUCTION

Discrete choice experiments (DCEs) have been used to measure patient and healthcare professionals preferences in a range of settings internationally. Using DCEs in primary care is valuable for determining how to improve rational shared decision making. The purpose of this systematic review is to assess the validity of the methods used for DCEs assessing the decision making of healthcare professionals in primary care.

MAIN BODY

A systematic search was conducted to identify articles with original data from a discrete choice experiment where the population was primary healthcare professionals. All publication dates from database inception to 29th February 2020 were included. A data extraction and validity assessment template based on guidelines was used. After screening, 34 studies met the eligibility criteria and were included in the systematic review. The sample sizes of the DCEs ranged from 10 to 3727. The published DCEs often provided insufficient detail about the process of determining the attributes and levels. The majority of the studies did not involve primary care healthcare professionals outside of the research team in attribute identification and selection. Less than 80% of the DCEs were piloted and few papers investigated internal or external validity.

CONCLUSIONS

For findings to translate into improvements in rational shared decision making in primary care DCEs need to be internally and externally valid and the findings need to be able to be communicated to stakeholders in a way that is understandable and relevant.

Can Urban-Rural Patterns of Hospital Selection Be Changed Using a Report Card Program? A Nationwide Observational Study

Background: Guiding patients to choose high-quality healthcare providers helps ensure that patients receive excellent care and helps reduce health disparities among patients of different socioeconomic backgrounds. The purpose of this study was to examine and compare the effect of implementing a report-card program on the patterns of hospital selection in patients from different socioeconomic subgroups. Patients undergoing total knee replacement (TKR) surgery were used as the sample population. Methods: A patient-level, retrospective, observational and cross-sectional study design was conducted. Taiwan National Health Insurance claims data were used and all patients in this database who had received TKR between April 2007–March 2008 (prior to report-card program implementation) and between April 2009–March 2010 (after program implementation) were included. Those patients who were under 18 years of age or who lacked area-of-residence or National Health Insurance premium information were excluded. Travelling distance to the hospital and level of hospital performance were used to evaluate the effect of the report-card program. Results: A total of 32,821 patients were included in this study. The results showed that patterns of hospital selection varied based on the socioeconomic characteristics of patients. In terms of travelling distance and hospital selection, the performance of urban and higher income patients was shorter and better, respectively, than their rural and lower-income peers both before and after report-card-program implementation. Moreover, although the results of multivariate analysis showed that the urban-rural difference in travelling distance enlarged (by 4.75 km) after implementation of the report-card program, this increase was shown to not be significantly related to this program. Furthermore, the results revealed that implementation of the report-card program did not significantly affect the urban-rural difference in terms of level of hospital performance. Conclusions: A successful report-card program should ensure that patients in all socioeconomic groups obtain comprehensive information. However, the results of this study indicate that those in higher socioeconomic subgroups attained more benefits from the program than their lower-subgroup peers. Ensuring that all have equal opportunity to access high-quality healthcare providers may therefore be the next issue that needs to be addressed and resolved.

Participating physician preferences regarding a pay-for-performance incentive design: a discrete choice experiment

OBJECTIVE

To determine whether the magnitude of incentives or other design attributes should be prioritized and the most important attributes, according to physicians, of the diabetes P4P (pay-for-performance) program design.

DESIGN

We implemented a discrete choice experiment (DCE) to elicit the P4P incentive design-related preferences of physicians.

PARTICIPANTS

All of the physicians (n = 248) who participated in the diabetes P4P program located in the supervisory area of the northern regional branch of the Bureau of National Health Insurance in 2009 were included. The response rate was ∼ 60%.

RESULTS

Our research found that the bonus type of incentive was the most important attribute, followed by the incentive structure and the investment magnitude.

CONCLUSIONS

Physicians may feel that good P4P designs are more important than the magnitude of the investment by the insurer. The two most important P4P designs include providing the bonus type of incentive and using pay-for-excellence plus pay-for-improvement.

The patient perspective of diabetes care: a systematic review of stated preference research

BACKGROUND

The importance of understanding the perspective of patients towards their own care is increasingly recognized, both in clinical practice and in pharmaceutical drug development. Stated preference methods to assess the preference of patients towards different aspects of diabetes treatment have now been applied for over a decade.

OBJECTIVE

Our goal was to examine how stated preference methods are applied in diabetes care, and to evaluate the value of this information in developing the patient perspective in clinical and policy decisions.

METHODS

A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The information sources were MEDLINE, EMBASE, Biosis, Current Contents, Web of Science, CINAHL, PsycINFO, and EconLit.

RESULTS

Three contingent valuation studies and 11 discrete choice experiments were retrieved. The majority of studies were conducted from 2009 onwards, but some date back to 1998. The reasons provided for applying the stated preference methods were to help differentiate between products, or to enable inclusion of the patient's perspective in treatment decisions. The main aspects of treatment examined were related to glucose control, adverse events, and drug administration. The majority of patients preferred glucose control over avoiding minor hypoglycemic events. Patient willingness to pay was above $US100/month for glucose control, avoiding immediate health hazards such as nausea, and oral or inhaled drug administration. Preference towards drug administration was highly associated with previous experience with injectable diabetes medicine.

CONCLUSIONS

The ability of a drug to lower glucose levels plays a decisive role in the choice between alternative treatments. Future research should strive to develop questionnaire designs relevant for the decision context of the study. That is, if the aim is to foster shared decision making, in clinical practice or drug development, this should guide the study design. Furthermore, concise reporting of all study dimensions-from the qualitative prework to the analysis stage-is warranted.

Applying discrete choice modelling in a priority setting: an investigation of public preferences for primary care models

OBJECTIVES

The shift toward more innovative and sustainable primary care models in Italy leads policy makers and clinicians to face difficult decisions between options that are all regarded as potentially beneficial. In this study, patient preferences for different primary care models in the Tuscany region of Italy were elicited. The relative importance of different attributes to the surveyed respondents was then examined, as well as the rate at which individuals trade between attributes and the relative value of different service configurations.

METHODS

A discrete choice experiment survey explored the following attributes in a stratified random sample of 6,970 adults: primary care provider, diagnostic facilities and waiting time for the visit.

RESULTS

Respondents (3,263) were likely to prefer a consultation by their own general practitioner (GP) and a practice with many diagnostic facilities. The predicted utilities of different service configurations have shown that a "primary care centre" with many diagnostic facilities was preferable to a "solo GP" model or a "group general practice".

CONCLUSIONS

The study demonstrated how a patient choice model could be used by decision makers for developing successful policies that takes into account different healthcare needs, balancing responsiveness with care continuity, equity and appropriateness. Considering that a primary care centre would perform better than a "solo GP", especially for younger respondents and for those with minor healthcare needs, for a more rapid diffusion of this model policymakers and managers could direct the care of primary care centres towards these targeted subgroups, at least in the first phase.

Discrete choice experiments in health economics: a review of the literature

BACKGROUND

Discrete choice experiments (DCEs) are increasingly used in health economics to address a wide range of health policy-related concerns.

OBJECTIVE

Broadly adopting the methodology of an earlier systematic review of health-related DCEs, which covered the period 2001-2008, we report whether earlier trends continued during 2009-2012.

METHODS

This paper systematically reviews health-related DCEs published between 2009 and 2012, using the same database as the earlier published review (PubMed) to obtain citations, and the same range of search terms.

RESULTS

A total of 179 health-related DCEs for 2009-2012 met the inclusion criteria for the review. We found a continuing trend towards conducting DCEs across a broader range of countries. However, the trend towards including fewer attributes was reversed, whilst the trend towards interview-based DCEs reversed because of increased computer administration. The trend towards using more flexible econometric models, including mixed logit and latent class, has also continued. Reporting of monetary values has fallen compared with earlier periods, but the proportion of studies estimating trade-offs between health outcomes and experience factors, or valuing outcomes in terms of utility scores, has increased, although use of odds ratios and probabilities has declined. The reassuring trend towards the use of more flexible and appropriate DCE designs and econometric methods has been reinforced by the increased use of qualitative methods to inform DCE processes and results. However, qualitative research methods are being used less often to inform attribute selection, which may make DCEs more susceptible to omitted variable bias if the decision framework is not known prior to the research project.

CONCLUSIONS

The use of DCEs in healthcare continues to grow dramatically, as does the scope of applications across an expanding range of countries. There is increasing evidence that more sophisticated approaches to DCE design and analytical techniques are improving the quality of final outputs. That said, recent evidence that the use of qualitative methods to inform attribute selection has declined is of concern.

Patient preferences for hospital quality: case study of iran

BACKGROUND

Due to the importance and uniqueness of the characteristics of the health sector, one of the most important priorities of the Ministry of Health is measuring the efficiency and quality of services which are provided for the people who refer to the health sectors. In all health systems, responding to the needs and wishes of patients is a crucial priority.

OBJECTIVES

The main purpose of this study is to prioritize the features of the services from the perspective of patients, by applying the Logit model.

MATERIALS AND METHODS

This study is a descriptive cross-sectional study and in terms of results it can be classified to an applied study. Data were collected by a questionnaire filled by 330 patients in Imam Khomeini hospital, and for estimating the utility function the software STATA version 10 was applied. In this study the preferences of patients who admitted to hospitals were identified by calculating the marginal utility of the characteristics, where we also used Marginal Rate substitutions (MRS).

RESULTS

Determination of the marginal utility characteristics shows that the first priority in receiving hospital services is the type of examination, and the last priority in the cleaning service of the sections and restrooms . Waiting time between hospital arrivals and admission has a negative sign which indicates a negative impact on patient preference.

CONCLUSIONS

The results of this study are consistent with studies by Kara Hanson and Barbara Mc Clean, where in their study they also showed that by the patient's perspective, hospital examination is the most important quality characteristic (coefficient = 2.78). In other words, the ultimate purpose of the hospital visit is the quality of service and examination, where many patients are willing to wait longer or pay higher costs to get the best services.

Preferences of people with diabetes for diabetic retinopathy screening: a discrete choice experiment

AIMS

The ever-increasing prevalence of diabetes places pressure on the provision of diabetic retinopathy screening services. As the first study of its kind, we aimed to determine preferences for diabetic retinopathy screening in people with diabetes and to examine the trade-offs between frequency of screening and other service attributes.

METHODS

A questionnaire including a discrete choice experiment was administered to people (n = 198) attending diabetic retinopathy screening at eight clinics across Wales, United Kingdom. The discrete choice experiment contained eight pairwise choices in which screening provision was described by five attributes: frequency of screening; travel time; results time; ability of screening to detect other changes; and explanation of results. Data were analysed using logistic regression techniques.

RESULTS

We gained a response rate of 86.4% from the 198 questionnaires administered at clinics; 160 complete responses were analysed. Respondents valued four out of the five attributes [ability of screening to detect other changes (P = 0.000), explanation of results (P = 0.024), frequency of screening (P = 0.000) and travel time (P = 0.007)]. Results time was insignificant (P = 0.122). Respondents were willing to wait an additional 12, 2 and 1 month between screening tests to have a test that was able to detect additional changes, to have their results explained in person rather than by letter and to have a 15-min reduction in travel time, respectively.

CONCLUSIONS

Respondents were willing to accept a longer screening interval, as long as preferences for other attributes of service provision (ability of screening to detect other changes, explanation of results and travel time) were made available.