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Snowdon DA, Collyer TA, Marsh L, Srikanth V, Beare R, Baber S, Naude K, Andrew NE. Healthcare consumer acceptability of routine use of the EQ-5D-5L in clinical care: a cross-sectional survey. Qual Life Res 2024; 33:1307-1321. [PMID: 38321194 PMCID: PMC11045645 DOI: 10.1007/s11136-024-03598-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] [Accepted: 01/02/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE Patient reported outcome measures, such as the EQ-5D-5L, provide a measure of self-perceived health status or health-related quality of life. Understanding the consumer acceptability of a patient reported outcome measure can help to decide about its implementation across a healthcare organisation and possibly increase the likelihood of its use in clinical care. This study established the acceptability of the EQ-5D-5L from the perspective of clients receiving healthcare, and determined if acceptability varied by client sub-types. METHODS A cross-sectional survey explored clients' experience of the EQ-5D-5L. Eligible clients were aged ≥ 18 years and completed the EQ-5D-5L on admission and discharge to one of two multi-disciplinary community health services. Likert scale items explored acceptability, and open-ended questions determined if the EQ-5D-5L reflects experience of illness. Associations between acceptability and client characteristics were established using χ2 test. Open-ended questions were analysed using content analysis. RESULTS Most of the 304 clients (mean age 70 years, SD 16) agreed that the EQ-5D-5L: was easy to use/understand (n = 301, 99%) and useful (n = 289, 95%); improved communication with their therapist (n = 275, 90%); and made them feel more in control of their health (n = 276, 91%). Most clients also agreed that they wished to continue using the EQ-5D-5L (n = 285, 93%). Clients aged ≥ 60 years reported lower acceptability. Clients noted that the EQ-5D-5L did not capture experience of illness related to fatigue, balance/falls, cognition, and sleep. CONCLUSION The EQ-5D-5L is acceptable for use in care but does not capture all aspects of health relevant to clients, and acceptability varies by subgroup.
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Affiliation(s)
- David A Snowdon
- National Centre for Healthy Ageing, 2 Hastings Road, Frankston, VIC, Australia.
- Academic Unit, Peninsula Health, Frankston, VIC, Australia.
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia.
| | - Taya A Collyer
- National Centre for Healthy Ageing, 2 Hastings Road, Frankston, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Lucy Marsh
- National Centre for Healthy Ageing, 2 Hastings Road, Frankston, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
| | - Velandai Srikanth
- National Centre for Healthy Ageing, 2 Hastings Road, Frankston, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Richard Beare
- National Centre for Healthy Ageing, 2 Hastings Road, Frankston, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia
| | - Stephanie Baber
- Physiotherapy Department, Golf Links Road Rehabilitation Centre, Peninsula Health, Frankston, VIC, Australia
| | - Kim Naude
- National Centre for Healthy Ageing, 2 Hastings Road, Frankston, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
| | - Nadine E Andrew
- National Centre for Healthy Ageing, 2 Hastings Road, Frankston, VIC, Australia
- Academic Unit, Peninsula Health, Frankston, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
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Ouwerkerk M, Rietberg MB, van der Linden MMW, Uitdehaag BMJ, van Wegen EEH, de Groot V. Mood Associated With Health- and Social Care-Related Quality of Life in Patients With Advanced Multiple Sclerosis. Int J MS Care 2024; 26:199-206. [PMID: 39091383 PMCID: PMC11293463 DOI: 10.7224/1537-2073.2023-060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
BACKGROUND Individuals with advanced multiple sclerosis (MS) have complex care requirements and are more likely to use long-term facilities. This study determined the associations between mood and social care-related quality of life (SCRQOL), and health-related quality of life (HRQOL) and examined the association between HRQOL and SCRQOL. METHODS Baseline data from a cohort study were used. Patients completed questionnaires, including the Hospital Anxiety and Depression Scale (HADS), Adult Social Care Outcomes Toolkit (ASCOT), and EuroQOL 5D-5L (EQ-5D-5L) and EQ-Visual Analogue Scale (EQ-VAS). Linear regression analyses were employed to assess the relationships between mood and both outcomes of QOL while controlling for relevant confounding factors (βs; 95% CI). The cross-sectional association between SCRQOL and HRQOL was examined using Pearson correlation coefficients (r). RESULTS A total of 75 patients, with a mean age of 56.1 years and a disease duration of 17.3 years, were enrolled from a long-term care facility in the Netherlands. Results showed that after controlling for confounders, HADS is an independent determinant of ASCOT (βs = -.368; 95% CI, -.581 to -.154) and EQ-5D-5L (βs = -.297; 95% CI, -.507 to -.087). Also, there are significant but weak correlations between ASCOT and EQ-5D-5L (r = 0.242; 95% CI, .015-.468), between ASCOT and EQ-VAS (r = 0.230; 95% CI, .003-.457) and between EQ-5D-5L and EQ-VAS (r = 0.227; 95% CI, .000-.454). CONCLUSIONS Mood, especially the depression component, is an important determinant of both HRQOL and SCRQOL in advanced MS. Focusing on mood in health care and social care may contribute to the improvement of QOL in a broader sense.
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Affiliation(s)
- Maaike Ouwerkerk
- Department of Rehabilitation Medicine, Neurosciences, MS Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Nieuw Unicum, Zandvoort, the Netherlands
| | - Marc B. Rietberg
- From the Department of Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Meike M. W. van der Linden
- Department of Rehabilitation Medicine, Neurosciences, MS Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Nieuw Unicum, Zandvoort, the Netherlands
| | - Bernard M. J. Uitdehaag
- Department of Neurology, Neurosciences, MS Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Erwin E. H. van Wegen
- From the Department of Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Vincent de Groot
- From the Department of Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
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O'Dwyer JL, Bryant LD, Hulme C, Kind P, Meads DM. Adapting the EQ-5D-3L for adults with mild to moderate learning disabilities. Health Qual Life Outcomes 2024; 22:37. [PMID: 38685039 PMCID: PMC11059748 DOI: 10.1186/s12955-024-02254-x] [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: 09/24/2023] [Accepted: 04/22/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Approximately 1.5 million adults in the UK have a learning disability. The difference between age at death for this group and the general population is 26 years for females and 22 years for males. The NHS Long Term Plan (January 2019) recognises learning disabilities as a clinical priority area. People with a learning disability are often excluded from research by design or lack of reasonable adjustments, and self-reported health status/health-related quality of life questionnaires such as the EQ-5D are often not appropriate for this population. Here, we systematically examine the EQ-5D-3L (its wording, content, and format) using qualitative methods to inform the adaption of the measure for use with adults with mild to moderate learning disabilities. METHODS Think-aloud interviews with carers/advocates of learning-disabled adults were undertaken to explore the difficulties with completing the EQ-5D-3L. Alternative wording, language, structure, and images were developed using focus groups, stakeholder reference groups, and an expert panel. Data analysis followed a framework method. RESULTS The dimensions and levels within the EQ-5D-3L were deemed appropriate for adults with mild to moderate learning disabilities. Consensus on wording, structure, and images was reached through an iterative process, and an adapted version of the EQ-5D-3L was finalised. CONCLUSION The EQ-5D-3L adapted for adults with mild to moderate intellectual/learning disabilities can facilitate measurement of self-reported health status. Research is underway to assess the potential use of the adaptation for economic evaluation.
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Affiliation(s)
- John L O'Dwyer
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL, UK.
| | - Louise D Bryant
- Division of Psychological & Social Medicine, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Worsley Building, Leeds, LS2 9JT, UK
| | - Claire Hulme
- Department of Health & Community Sciences, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK
| | - Paul Kind
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK
| | - David M Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Leeds, LS2 9NL, UK
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Xu RH, Ma B, Xin H, Zhang H, Zeng Y, Luo N, Dong D. Measurement properties of the EQ-5D-5L and PROPr in patients with spinal muscular atrophy. Health Qual Life Outcomes 2023; 21:123. [PMID: 37968716 PMCID: PMC10647137 DOI: 10.1186/s12955-023-02204-z] [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: 07/10/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVES Spinal muscular atrophy (SMA) is a rare monogenic neuromuscular disorder caused by loss of function mutations. Measuring health-related quality of life to support economic evaluations in this population is encouraged. However, empirical evidence on the performance of preference-based measures (PBMs) in individuals with SMA is limited. This study aimed to assess the psychometric properties of the EQ-5D-5L and the Patient-Reported Outcomes Measure Information System Preference measure (PROPr) in individuals with SMA. METHODS The data used in this study were obtained via a web-based, cross-sectional survey. All participants completed the self-reporting EQ-5D-5L and PROMIS-29 questionnaires. Information about their socioeconomic and health status was also obtained. Ceiling and floor effects, convergent and divergent validity, known-group validity, and the agreement between the two measures were assessed. RESULTS Strong ceiling and floor effects were observed for four dimensions of the EQ-5D-5L and three subscales, including pain intensity, pain interference, and physical function, of the PROMIS-29. All hypothesized associations between EQ-5D-5L/PROMIS-29 and other neuromuscular questions were confirmed, supporting good convergent validity. Moreover, both EQ-5D-5L and PROPr scores differentiated between impaired functional groups, demonstrating good discriminative ability. Poor agreement between the EQ-5D-5L and PROPr utility scores was observed. CONCLUSIONS The EQ-5D-5L and PROPr both appear to be valid PBMs for individuals with SMA. However, PROPr yielded considerably lower utility scores than EQ-5D-5L and their agreement was poor. Therefore, these two PBMs may not be used interchangeably in economic evaluations of SMA-related interventions.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Bin Ma
- Meier Advocacy & Support Center for SMA, Beijing, China
| | - Huanping Xin
- Meier Advocacy & Support Center for SMA, Beijing, China
| | - Huanyu Zhang
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Yan Zeng
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Dong Dong
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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Engel L, Kosowicz L, Bogatyreva E, Batchelor F, Devlin N, Dow B, Gilbert AS, Mulhern B, Peasgood T, Viney R. Face Validity of Four Preference-Weighted Quality-of-Life Measures in Residential Aged Care: A Think-Aloud Study. THE PATIENT 2023; 16:655-666. [PMID: 37803217 PMCID: PMC10570159 DOI: 10.1007/s40271-023-00647-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE There is an increased use of preference-weighted quality-of-life measures in residential aged care to guide resource allocation decisions or for quality-of-care assessments. However, little is known about their face validity (i.e., how understandable, appropriate and relevant the measures are 'on their face' when respondents complete them). The aim of this study was to assess the face validity of four preference-weighted measures (i.e., EQ-5D-5L, EQ-HWB, ASCOT, QOL-ACC) in older people living in residential aged care. METHODS Qualitative cognitive think-aloud interviews were conducted using both concurrent and retrospective think-aloud techniques. To reduce burden, each resident completed two measures, with the four measures randomised across participants. Audio recordings were transcribed and framework analysis was used for data analysis, based on an existing framework derived from the Tourangeau four-stage response model. RESULTS In total, 24 interviews were conducted with residents living across three residential aged care facilities in Melbourne, Australia. Response issues were identified across all four measures, often related to comprehension and difficulty selecting a response level due to double-barrelled and ambiguous items that have different meanings in the residential aged care context. We also identified issues related to understanding instructions, non-adherence to the recall period, and noted positive responding that requires attention when interpreting the data. CONCLUSIONS Our findings provide further evidence on the appropriateness of existing measures, indicating numerous response issues that require further research to guide the selection process for research and practice.
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Affiliation(s)
- Lidia Engel
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Leona Kosowicz
- National Ageing Research Institute, Parkville, VIC, Australia
| | - Ekaterina Bogatyreva
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Public Health and Social Development, Deakin University, Burwood, VIC, Australia
| | - Frances Batchelor
- National Ageing Research Institute, Parkville, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
| | - Nancy Devlin
- The University of Melbourne, Parkville, VIC, Australia
| | - Briony Dow
- National Ageing Research Institute, Parkville, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
| | - Andrew S Gilbert
- National Ageing Research Institute, Parkville, VIC, Australia
- Department of Social Inquiry, La Trobe University, Bundoora, VIC, Australia
| | - Brendan Mulhern
- The Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | | | - Rosalie Viney
- The Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, 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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Ren W, Tarimo CS, Liang Z. Current state, equality level and trends of self-rated health among old adults with intact physical condition. BMC Public Health 2023; 23:1056. [PMID: 37264357 DOI: 10.1186/s12889-023-15970-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/24/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Self-rated health among old adults (SHOA) indicates individuals' subjective assessments and evaluations of their overall health based on objective physical circumstances. The purpose of this study was to analyze the current state and influencing factors of the subjective perception-based self-rated health (SH) by qualifying selected older adults with similar objective physical conditions, as well as to explore the equality and changing trends of SHOA based on influencing factors. METHODS This study designed a cross-sectional study, conducted in three provinces in east, central and west China, and included 1,153 older adults (> = 60 years) with intact physical condition (IPC). The current state of SHOA and its influencing factors were analyzed using mean comparisons and Logistic regression (LR) models. The equality level and trend of SHOA's effect on health literacy, health habits, and access to health care were determined using the Lorenz curve, Gini coefficient, and Vector Autoregression (VAR) model. RESULTS The mean SHOA with IPC was 74.37 ± 13.22. Findings from LR modeling indicated that SHOA with IPC was mainly influenced by age and communication methods (P < 0.05). It was also observed that the total Gini coefficient of the allocation of SHOA with IPC based on communication methods was equal to 0.0188, and the VAR results showed that the total effect of change in SHOA on health literacy among older adults was negative and its duration of the effect exceeded 50. CONCLUSIONS The SHOA with IPC was shown to be better and was primarily influenced by age and communication methods. The observed effect of SHOA on health literacy was negative and lasting. To improve SHOA with IPC even further, policymakers could consider promoting the use of modern and convenient communication methods (such as smartphones) through training and purchasing subsidies, as well as focusing on increasing sustained attention and promoting health literacy and behavior among older adults with improved SH.
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Affiliation(s)
- Weicun Ren
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
- Wuhan University Health Governance Research Centre, Wuhan University, Wuhan, China
| | - Clifford Silver Tarimo
- College of Public Health, Zhengzhou University, Zhengzhou, China
- Department of Science and Laboratory Technology, Dares Salaam Institute of Technology, Dar Es Salaam, Tanzania
| | - Zhang Liang
- School of Political Science and Public Administration, Wuhan University, Wuhan, China.
- Wuhan University Health Governance Research Centre, Wuhan University, Wuhan, China.
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Britten L, Pina I, Nykjaer C, Astill S. Dance on: a mixed-method study into the feasibility and effectiveness of a dance programme to increase physical activity levels and wellbeing in adults and older adults. BMC Geriatr 2023; 23:48. [PMID: 36703116 PMCID: PMC9878484 DOI: 10.1186/s12877-022-03646-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/23/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Physical activity (PA) has beneficial effects on physical and mental health outcomes in older adults. However, a consistent decline in PA participation has been noted with increasing age, with older adults consistently being reported as the least physically active population. Previous evidence showed that dance is an appropriate form of PA in older adults as it integrates the body's movement with physical, cognitive, and social elements. This study investigated the feasibility and efficacy of a weekly dance programme over a 12-month period on PA levels and wellbeing. METHODS A mixed-method intervention design was used. Community-dwelling older adults aged 55 + years were recruited from local community groups in Yorkshire (UK). The programme comprised of a 60-min mixed genre dance class per week. Changes with carried forward data in self-reported measures of PA (min/week) and wellbeing with EuroQol visual analogue scale (EQ VAS) across four different time points (baseline, 3, 6 and 12 months) were assessed using the Friedman test. Feasibility was also assessed through class attendance and focus groups (N = 6-9) with participants. A thematic analysis of qualitative data was conducted. RESULTS A total of 685 participants (589-89.1% females and 72-10.9% males) took part in the study. The mean age was 75 ± 10 years, and 38% of the participants were classed as highly deprived as per the index of multiple deprivation. There was a statistically significant increase in both PA (X2(3) = 192.42, P < 0.001) and EQ VAS scores across the four time points (X2(3) = 19.66, P < 0.001). The mean adherence rate was consistent across the 12-month period of intervention (70%). Themes from the focus groups included reasons for participating in the programme, perceptions of how the dance programme affected the participants, and facilitators to participation in the programme. CONCLUSIONS The good adherence and favourability indicate that the dance programme is feasible as an intervention in community-dwelling participants from socially economically diverse communities. The dance intervention showed a positive effect on PA levels and wellbeing. A randomised-controlled trial with a control group is required to test this intervention further.
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Affiliation(s)
- Laura Britten
- Miall Building, School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Ilaria Pina
- Miall Building, School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Camilla Nykjaer
- Miall Building, School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Sarah Astill
- Miall Building, School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, LS2 9JT, UK.
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Penton H, Dayson C, Hulme C, Young T. A Qualitative Investigation of Older Adults' Conceptualization of Quality of Life and a Think-Aloud Content Validation of the EQ-5D-5L, SF-12v2, Warwick Edinburgh Mental Wellbeing Scale, and Office of National Statistics-4. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:2017-2027. [PMID: 35760713 DOI: 10.1016/j.jval.2022.04.1735] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/11/2022] [Accepted: 04/24/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Old age is characterized by declining health, comorbidities, and increasing health and social care service use. Traditionally, patient-reported outcome measures (PROMs) including the EQ-5D-5L and SF-12v2 have focused on health. Nevertheless, aged care often aims to improve broader elements of quality of life (QoL), captured by well-being measures, such as the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) and Office of National Statistics-4 (ONS-4). This study investigates older adults' conceptualization of QoL and the content validity of the EQ-5D-5L, SF-12v2, WEMWBS, and ONS-4 in measuring their QoL. METHODS Qualitative cognitive think-aloud interviews were undertaken with older adults aged 75+, exploring their views on what was important to QoL and, for each measure, the relevance, acceptability, and interpretation of items; suitability of response options; and the comprehensiveness of the measure. Conceptualization of QoL was analyzed thematically and content validity using framework analysis. RESULTS Twenty interviews were undertaken. Older adults' conceptualization of QoL centered on health, ability to perform usual activities, social contact, and emotional functioning. Possible response shift was observed, as older adults assessed their health relative to lower health expectations at their age or to people in worse states. Participants questioned the relevance of negatively phrased mental items and often preferred the functioning-focused EQ-5D-5L to more subjective ONS-4 and WEMWBS items. Domains suggested to improve comprehensiveness included social contact, coping, security, dignity, and control. CONCLUSIONS These findings are useful to researchers developing new PROMs for older adults or for the developers of included PROMs considering permanently adapting or bolting-on domains to improve content validity in older adults.
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Affiliation(s)
- Hannah Penton
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK.
| | - Christopher Dayson
- Centre for Regional Economic and Social Research, Advanced Wellbeing Research Centre, Sheffield, England, UK
| | - Claire Hulme
- Institute of Health Research, South Cloisters, University of Exeter, Exeter, England, UK
| | - Tracey Young
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
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Robinson ES, Cyarto E, Ogrin R, Green M, Lowthian JA. Quality of life of older Australians receiving home nursing services for complex care needs. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6091-e6101. [PMID: 36200317 DOI: 10.1111/hsc.14046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/04/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Older Australians may live up to 10 years in ill health, most likely chronic disease-related. Those with multimorbidity report more healthcare visits, poorer health and take more medications compared with people with a single chronic disease. They are also at higher risk of hospital admission and poor quality of life. People living with multimorbidity are considered to have "complex care" needs. A person-centred approach to healthcare has led to increasing use of in-home nursing support, enabling older people to receive care at home. Our prospective observational study describes the profile and management of home-based care for older people with complex care needs and examines changes in their quality of life over 12 months. Routinely collected data were analysed, including demographics, medical history, medications and the visit activity of staff providing care to participants. Additional health-related quality of life and hospitalisation data were collected via quarterly surveys and analysed. Fifty-two participants (mean age 76.6 years, 54% female) with an average of eight diagnosed health conditions, received an average of four home care visits per week. Almost half the participants were hospitalised once during the 12-month period and experienced a significant decline in overall quality of life and in the dimensions measuring independent living and relationships over the study period. If ageing in place with good quality of life is to be realised by older adults with multimorbidity, support services including home nursing need to consider both the biomedical and social determinants perspectives when addressing health and social care needs.
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Affiliation(s)
| | - Elizabeth Cyarto
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Rajna Ogrin
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
- Department of Business Strategy and Innovation, Griffith University, Nathan, Queensland, Australia
| | - Maja Green
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
| | - Judy A Lowthian
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
- School of Public Health & Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
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11
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Buchholz I, Marten O, Janssen MF. Feasibility and validity of the EQ-5D-3L in the elderly Europeans: a secondary data analysis using SHARE(d) data. Qual Life Res 2022; 31:3267-3282. [PMID: 35624409 PMCID: PMC9546963 DOI: 10.1007/s11136-022-03158-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE To determine feasibility and validity of the EQ-5D-3L in the elderly European population. METHODS Secondary data analysis based on the study of health, ageing, and retirement in Europe (SHARE) to determine the percentage of missing items for EQ-5D dimensions and EQ VAS, and to demonstrate convergent/divergent validity with measures included in the SHARE survey. Known-groups validity was tested using literature-based hypotheses. Correlation coefficients and Cohen's f are reported. RESULTS Missing values were below 3% across all EQ-5D dimensions and gender strata, slightly increasing with age. Individuals' responses to each EQ-5D dimension were related to their ratings of other measures in expected directions. The EQ VAS and all EQ-5D dimensions (except anxiety/depression) moderately to strongly correlated with physical [e.g. number of limitations in activities of daily living (ADL): r = 0.313-0.658] and generic measures [CASP (control, autonomy, self-realization, pleasure)-19 scale, self-perceived health, number of symptoms: r = 0.318-0.622], while anxiety/depression strongly correlated with the EURO-D scale (r = 0.527). Both EQ-5D dimensions and EQ VAS discriminated well between two [or more] groups known to differ [e.g. anxiety/depression discriminated well between persons classified as depressed/not depressed using the EURO-D scale, f = 0.51; self-care differentiated best between individuals without and with 1 + ADL limitations, f = 0.69]. Sociodemographic variables like gender, education, and partner in household were hardly associated with EQ VAS scores (f < 0.25). CONCLUSION With item non-response of less than 3%, good discriminatory, and construct properties, the EQ-5D-3L showed to be a feasible and valid measure in the elderly Europeans.
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Affiliation(s)
| | - Ole Marten
- Department of Health Economics and Health Care Management, Bielefeld University, 33615, Bielefeld, Germany
| | - Mathieu F Janssen
- Department of Medical Psychology and Psychotherapy Erasmus MC, Erasmus University, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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12
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Sanghera S, Walther A, Peters TJ, Coast J. Challenges in Using Recommended Quality of Life Measures to Assess Fluctuating Health: A Think-Aloud Study to Understand How Recall and Timing of Assessment Influence Patient Responses. THE PATIENT 2022; 15:445-457. [PMID: 34854064 PMCID: PMC9197908 DOI: 10.1007/s40271-021-00555-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 10/29/2022]
Abstract
BACKGROUND It can be challenging to measure quality of life to calculate quality-adjusted life-years in recurrent fluctuating health states, as quality of life can constantly change. It is not clear how patients who experience fluctuations complete measures and how assessment timing and recall influence responses. OBJECTIVE We aimed to understand how patients with fluctuating health complete widely recommended and commonly used measures (EQ-5D-5L, EORTC QLQ-C30 and SF-12) and the extent to which the recall period ('health today', 'past week' and 'past 4 weeks') and timing of assessment influence the way that patients complete these questionnaires. METHODS Twenty-four adult patients undergoing chemotherapy for urological, gynaecological or bowel cancers in the UK participated in think-aloud interviews, while completing the measures, completed a pictorial task illustrating how quality of life changed during the chemotherapy cycle and took part in semi-structured interviews. Transcripts were analysed using constant comparison. RESULTS Patients were consistent in describing their quality of life as changing considerably throughout a chemotherapy cycle. The shorter recall period of 'health today' does not adequately represent patients' quality of life because of fluctuations, patients remarked they could give a different answer depending on the timing of assessment, and many struggled to combine the "ups and downs" to answer measures with longer recall ('past week' and 'past 4 weeks'). Across all measures, patients attempted to provide averages, adopt the peak-end rule or focus on the best part of their experience. Patients commonly used more than one approach when completing a given questionnaire as well as across questionnaires. CONCLUSIONS Patients who experience recurrent fluctuations in health are unable to provide meaningful responses about their quality of life when completing quality-of-life measures due to the recall period and timing of assessment. The use of such responses to calculate health state values in economic evaluations to inform resource allocation decisions in fluctuating conditions must be questioned.
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Affiliation(s)
- Sabina Sanghera
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK.
| | - Axel Walther
- Bristol Cancer Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Tim J Peters
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanna Coast
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
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Clifford AM, Ni Bhriain O, Byrne S, Cheung PS, Louw Q, Glynn L, Moss H, O'Neill D, Woods CB, Sheikhi A, Gowran RJ, Maher C, Kennelly B, Salsberg J, Thabane L. Music and Movement for Health: Protocol for a pragmatic cluster-randomised feasibility pilot trial of an arts-based programme for the health and wellbeing of older adults. HRB Open Res 2022; 5:42. [PMID: 36726486 PMCID: PMC9843089 DOI: 10.12688/hrbopenres.13535.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Arts-based health programmes (ABHP) can enhance the physical and psychosocial health and wellbeing of older people. However, the feasibility and usefulness of such programmes in Ireland are currently unknown. The primary aim of this study is to examine the feasibility of the study design, its application to a music and movement for health programme and associated costs. The secondary aim is to obtain preliminary effect estimates of an ABHP on health and wellbeing in older adults. Methods: This study is a pragmatic cluster-randomised controlled feasibility trial. Community-dwelling adults, aged 65 years or older will be recruited in the mid-west region of Ireland via methods including social prescription, traditional and social media. The clusters, based on geographical region, will be block randomised to either the ABHP or control using 1:1 allocation ratio. The programme will comprise a 1.5-hour music and dance session each week for 12-weeks together with a 1-hour home-based music and movement programme for 12-weeks. A qualitative and quantitative process evaluation of the arts-based health programme will be performed. Outcomes: Primary outcomes for feasibility include recruitment rates (the number of participants recruited per cluster per month); retention rate (the number of participants who complete measures at baseline and at follow up post intervention, and minimum average attendance. Secondary outcomes will include physical function, balance, physical activity, loneliness, social isolation, cognition, mood, as well as quality of life and cost. Conclusions: If this pioneering study finds evidence to support feasibility and acceptability, a future larger-scale definitive trial will be conducted to examine the effectiveness of an arts-based health programme for older adults. This research aims to strengthen collaborative efforts to implement effective, sustainable and cost-effective programmes for older adults to support community connection, enhancing health and wellbeing, in turn reducing demands on the healthcare system. ISRCTN registration: ISRCTN35313497 (18/02/2022).
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Affiliation(s)
- Amanda M. Clifford
- School Of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94T9PX, Ireland,
| | - Orfhlaith Ni Bhriain
- Irish World Academy of Music and Dance, University of Limerick, Limerick, V94DK18, Ireland
| | - Steven Byrne
- School Of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94T9PX, Ireland
| | - Pui-Sze Cheung
- School Of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94T9PX, Ireland
| | - Quinette Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liam Glynn
- School of Medicine, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Hilary Moss
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Desmond O'Neill
- Centre for Ageing, Neuroscience and the Humanities, Trinity College Dublin, Dublin, Ireland
| | - Catherine B. Woods
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ali Sheikhi
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Rosemary Joan Gowran
- School Of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94T9PX, Ireland,Assisting Living and Learning (ALL) Institute, Maynooth University, Maynooth, Ireland
| | - Catherine Maher
- Rehabilitation Unit, Community Hospital of the Assumption, Thurles, Tipperary, Ireland
| | - Brendan Kennelly
- Cairnes School of Business and Economics, National University of Ireland Galway, Galway, Ireland
| | - Jon Salsberg
- School of Medicine, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Lehana Thabane
- Department of Health Research Methods, Institute for Research in Ageing, McMaster University, Canada
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14
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Marten O, Greiner W. Feasibility properties of the EQ-5D-3L and 5L in the general population: evidence from the GP Patient Survey on the impact of age. HEALTH ECONOMICS REVIEW 2022; 12:28. [PMID: 35593942 PMCID: PMC9121571 DOI: 10.1186/s13561-022-00374-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/11/2022] [Indexed: 05/09/2023]
Abstract
BACKGROUND There is evidence to suggest that the proportion of missing values is slightly higher in the older population resulting in lower completion rates of the EQ-5D. However, existing studies rarely provide a within-sample comparison of feasibility properties across age groups to quantify this difference. Hence, this study examines feasibility properties of the EQ-5D-3L and 5L in the general population and explores the impact of age on the completion of EQ-5D instruments. METHODS We pool five waves from the English GP Patient Survey, where respondents self-report their health in either EQ-5D-3L or 5L. Descriptive analysis was undertaken to analyse the distribution and proportion of missing values and completion rates stratified by age and EQ-5D version; logistic regression models were specified to quantify the impact of age, gender and potential long-term conditions on the completion of each of the EQ-5D instruments. RESULTS The total sample comprises ~ 4.36 million observations, of which 2.88 million respondents report their health in 5L and 1.47 million in 3L, respectively. Respondents over 64 years have slightly more missing values in each dimension than younger respondents. The highest share was observed for the oldest age group in the dimension anxiety/depression (3L 9.1% vs. 5L 7.6%), but was otherwise below 5%. Consequently, completion rates (observed and predicted) decreased with older age and at a higher rate after the age of 64; this was more pronounced for the 3L. CONCLUSION Evidence from our study suggests that both the EQ-5D-3L and 5L have good feasibility properties. In comparison to younger populations there appears to be a higher proportion of respondents with incomplete responses beyond the age of 64 years. Overall, the 5L version compares more favourably in terms of missing values, completion rates as well as with regard to the expected probability of an incomplete descriptive system.
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Affiliation(s)
- Ole Marten
- School of Public Health, Department of Health Economics and Health Care Management, Bielefeld University, Universitaetsstrasse 25, Bielefeld, Germany.
| | - Wolfgang Greiner
- School of Public Health, Department of Health Economics and Health Care Management, Bielefeld University, Universitaetsstrasse 25, Bielefeld, Germany
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15
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Clifford AM, Ni Bhriain O, Byrne S, Cheung PS, Louw Q, Glynn L, Moss H, O'Neill D, Woods CB, Sheikhi A, Gowran RJ, Maher C, Kennelly B, Salsberg J, Thabane L. Music and Movement for Health: Protocol for a pragmatic cluster-randomised feasibility pilot trial of an arts-based programme for the health and wellbeing of older adults. HRB Open Res 2022; 5:42. [PMID: 36726486 PMCID: PMC9843089.2 DOI: 10.12688/hrbopenres.13535.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
Background: Arts-based health programmes (ABHP) can enhance the physical and psychosocial health and wellbeing of older people. However, the feasibility and usefulness of such programmes in Ireland are currently unknown. The primary aim of this study is to examine the feasibility of the study design, its application to a music and movement for health programme and associated costs. The secondary aim is to obtain preliminary effect estimates of an ABHP on health and wellbeing in older adults. Methods: This study is a pragmatic cluster-randomised controlled feasibility trial. Community-dwelling adults, aged 65 years or older will be recruited in the mid-west region of Ireland via methods including social prescription, traditional and social media. The clusters, based on geographical region, will be block randomised to either the ABHP or control using 1:1 allocation ratio. The programme will comprise a 1.5-hour music and dance session each week for 12-weeks together with a 1-hour home-based music and movement programme for 12-weeks. A qualitative and quantitative process evaluation of the arts-based health programme will be performed. Outcomes: Primary outcomes for feasibility include recruitment rates (the number of participants recruited per cluster per month); retention rate (the number of participants who complete measures at baseline and at follow up post intervention, and minimum average attendance. Secondary outcomes will include physical function, balance, physical activity, loneliness, social isolation, cognition, mood, as well as quality of life and cost. Conclusions: If this pioneering study finds evidence to support feasibility and acceptability, a future larger-scale definitive trial will be conducted to examine the effectiveness of an arts-based health programme for older adults. This research aims to strengthen collaborative efforts to implement effective, sustainable and cost-effective programmes for older adults to support community connection, enhancing health and wellbeing, in turn reducing demands on the healthcare system. ISRCTN registration: ISRCTN35313497 (18/02/2022).
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Affiliation(s)
- Amanda M. Clifford
- School Of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94T9PX, Ireland
| | - Orfhlaith Ni Bhriain
- Irish World Academy of Music and Dance, University of Limerick, Limerick, V94DK18, Ireland
| | - Steven Byrne
- School Of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94T9PX, Ireland
| | - Pui-Sze Cheung
- School Of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94T9PX, Ireland
| | - Quinette Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liam Glynn
- School of Medicine, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Hilary Moss
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Desmond O'Neill
- Centre for Ageing, Neuroscience and the Humanities, Trinity College Dublin, Dublin, Ireland
| | - Catherine B. Woods
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ali Sheikhi
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Rosemary Joan Gowran
- School Of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, V94T9PX, Ireland
- Assisting Living and Learning (ALL) Institute, Maynooth University, Maynooth, Ireland
| | - Catherine Maher
- Rehabilitation Unit, Community Hospital of the Assumption, Thurles, Tipperary, Ireland
| | - Brendan Kennelly
- Cairnes School of Business and Economics, National University of Ireland Galway, Galway, Ireland
| | - Jon Salsberg
- School of Medicine, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Lehana Thabane
- Department of Health Research Methods, Institute for Research in Ageing, McMaster University, Canada
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16
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Marten O, Brand L, Greiner W. Feasibility of the EQ-5D in the elderly population: a systematic review of the literature. Qual Life Res 2021; 31:1621-1637. [PMID: 34613597 PMCID: PMC9098572 DOI: 10.1007/s11136-021-03007-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 11/29/2022]
Abstract
Purpose The EQ-5D-3L and 5L are widely used generic preference-based instruments, which are psychometrically sound with the general population, but little is known about the instruments’ feasibility in the elderly. Therefore, this systematic review summarises the available literature with regard to the feasibility properties of the instruments in the elderly population. Methods We conducted a systematic search in PubMed, PsycInfo and EuroQol databases using pre-specified vocabulary and inclusion/exclusion criteria to identify publications until November 2020. Study characteristics and outcomes referring to the feasibility of the EQ-5D-3L and 5L in the elderly were extracted, if all study participants were at least 65+ years. Results We identified 17 studies reporting feasibility outcomes based on four criteria: missing values, completion rates, completion time and broad qualitative statements referring to the completion. Missing values per dimension ranged from 0 to 10.7%, although being mostly below 7%. The completion rate was around 90% or better, whereas the EQ VAS rating was missing from 2.3 to 25.3% of the respondents. Only two of the included studies examined the EQ-5D-5L; 15 studies reported on the EQ-5D-3L. Conclusion Comparing our findings against the general population from published literature, we find that feasibility outcomes in older age groups are just below that of younger populations. Furthermore, older respondents have a higher propensity of requiring assistance or even an interviewer-based approach. Nonetheless, the reviewed literature indicates that the EQ-5D-3L still has good feasibility properties and, hence, is highly applicable in older respondents. However, further research is needed to explore feasibility properties of the EQ-5D-5L in this population.
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Affiliation(s)
- Ole Marten
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitaetsstrasse 25, Bielefeld, Germany.
| | - Laura Brand
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitaetsstrasse 25, Bielefeld, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitaetsstrasse 25, Bielefeld, Germany
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17
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Self- and proxy-rating of the ICECAP-O for people with dementia: A cross-sectional linguistic validation study in Germany and Portugal. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2021; 162:24-31. [PMID: 33811016 DOI: 10.1016/j.zefq.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/05/2021] [Accepted: 02/25/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The capability concept became a recognized approach to the measurement of quality of life. The ICECAP-O for older people aims to measure capabilities and has recently been used in people with dementia (self-rating) and informal carers (substituted judgement). However, linguistic validation studies have so far been lacking. METHODS A cross-sectional cognitive interview study with 15 people with dementia (PwD) and 23 informal carers (ICs) was conducted in Germany and Portugal. Respondents were asked to reveal their understanding of the ICECAP-O and the capability approach as well as the response process. A summarising content analysis was performed. RESULTS Despite the small sample, our linguistic validation of the German and Portuguese translations detected considerable difficulties or deviations in item comprehension when compared with the intended meaning. In some cases, the item interpretations did not reflect the entire scope of the associated capability dimension, though they were basically correct. Moreover, participants were not able to differentiate some items appropriately from one another, and some misinterpretations occurred. ICs relied mainly on observable behaviour, emotions, or verbal expressions of the PwD. Therefore, ICs found items that ask about the achievement of individual expectations or thoughts about the future difficult to assess. Only very few PwD clearly indicated that they understood the capability approach. ICs in Germany had more difficulties in understanding the capability concept than in ICs Portugal. DISCUSSION This linguistic validation study in Germany and Portugal indicates a need for some rephrasing and refinements of the ICECAP-O translated items in both countries to fully encompass some dimensions and avoid misinterpretations. Further studies with larger samples are necessary. Based on our findings, the current German version for ICs' substituted judgement cannot be recommended for this kind of respondents without further advancements.
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18
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Krig S, Åström M, Kulane A, Burström K. Acceptability of the health-related quality of life instrument EQ-5D-Y-5L among patients in child and adolescent psychiatric inpatient care. Acta Paediatr 2021; 110:899-906. [PMID: 32815186 PMCID: PMC7983875 DOI: 10.1111/apa.15547] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/02/2020] [Accepted: 08/18/2020] [Indexed: 11/27/2022]
Abstract
Aim The generic EuroQol 5 Dimensions Youth 5 Level (EQ‐5D‐Y‐5L) measures health‐related quality of life among children from 8 years. Respondents report their health on five dimensions with five severity levels and rate their overall health on a visual analogue scale (EQ VAS). The aim of the study was to explore acceptability of the EQ‐5D‐Y‐5L instrument among patients in child and adolescent psychiatric inpatient care. Methods A convenience sample of patients within a psychiatric inpatient care clinic in Region Stockholm, Sweden, was used. Follow‐up questions were answered directly after filling in the EQ‐5D‐Y‐5L. Conventional qualitative content analysis was chosen to analyse the open‐ended questions on how they perceived answering the instrument. Results In total, 52 patients (83% girls), mean age 15.4 years (range 13‐17), were included. Three themes emerged: generic content of the EQ‐5D‐Y‐5L descriptive system; design and wording of the EQ‐5D‐Y‐5L descriptive system and the EQ VAS; self‐reporting health with the EQ‐5D‐Y‐5L descriptive system and the EQ VAS. Conclusion The inclusion of physical health dimensions was perceived as positive, but some patients considered the descriptive system too generic. The results indicate that these patients in general could self‐report their health in a meaningful way with the EQ‐5D‐Y‐5L instrument.
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Affiliation(s)
- Sonja Krig
- Health Outcomes and Economic Evaluation Research Group Department of Learning Informatics, Management and Ethics Stockholm Centre for Healthcare Ethics Karolinska Institutet Stockholm Sweden
| | - Mimmi Åström
- Health Outcomes and Economic Evaluation Research Group Department of Learning Informatics, Management and Ethics Stockholm Centre for Healthcare Ethics Karolinska Institutet Stockholm Sweden
- Equity and Health Policy Research Group Department of Global Public Health Karolinska Institutet Stockholm Sweden
- Health Care Services, Region Stockholm Stockholm Sweden
| | - Asli Kulane
- Equity and Health Policy Research Group Department of Global Public Health Karolinska Institutet Stockholm Sweden
| | - Kristina Burström
- Health Outcomes and Economic Evaluation Research Group Department of Learning Informatics, Management and Ethics Stockholm Centre for Healthcare Ethics Karolinska Institutet Stockholm Sweden
- Equity and Health Policy Research Group Department of Global Public Health Karolinska Institutet Stockholm Sweden
- Health Care Services, Region Stockholm Stockholm Sweden
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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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Rohr M, Brandstetter S, Plomer AS, Loss J, Kretschmer R, Apfelbacher C. A qualitative study exploring content validity and feasibility of frequently used generic health-related quality of life measures in older people with hip fracture: The patients' perspective. Injury 2021; 52:134-141. [PMID: 33039180 DOI: 10.1016/j.injury.2020.09.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/07/2020] [Accepted: 09/27/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate hip fracture patients´ views on content validity and feasibility of four commonly used generic measures of health-related quality of life (HRQOL). METHODS We interviewed 32 elderly hip fracture patients without relevant cognitive impairment (mean age=81 years). Using think-aloud and verbal probing techniques, patients completed the EQ-5D descriptive system, Nottingham Health Profile (NHP), Short-Form 12 Health Questionnaire (SF-12) and WHO Quality of Life-BREF (WHOQOL-BREF). RESULTS Patients were mostly not able to self-complete the questionnaires. Content validity was most constrained by problems in comprehensibility (e.g. vaguely phrased). Some items, for instance, were considered irrelevant if the example was inappropriate. Patients named e.g. problems with vision as important for their HRQOL, but none of the instruments included related items. CONCLUSION Although patients reported problems with all instruments, we suggest the EQ-5D or SF-12, as these appear to have the fewest limitations in content validity and feasibility from the patient´s perspective.
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Affiliation(s)
- Magdalena Rohr
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
| | - Susanne Brandstetter
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany; University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Regensburg, Germany
| | - Anna-Sophie Plomer
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Julika Loss
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | | | - Christian Apfelbacher
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany; Institute for Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany; Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
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Hendriks I, Demetrio R, Meiland FJM, Chattat R, Szcześniak D, Rymaszewska J, Ettema TP, Evans SB, Brooker D, Evans SC, Atkinson T, Farina E, Saibene FL, Gerritsen DL, Dröes RM. Value of Personalized Dementia-Specific Quality of Life Scales: An Explorative Study in 3 European Countries. Am J Alzheimers Dis Other Demen 2021; 36:15333175211033721. [PMID: 34424058 PMCID: PMC10581102 DOI: 10.1177/15333175211033721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Measuring Quality of Life (QOL) can be difficult due to its individual character. To explore the value of personalized QOL measurement for people with dementia, personalized versions of two dementia-specific QOL scales (Dementia quality of Life (DQoL) and Quaility of Life in Alzheimer's Disease (QoL-AD)) were constructed. This study investigated whether the personalized measures are more valid to detect variations in QOL than their standard versions for people with mild to moderate dementia, with sufficient internal consistency. Moreover, the relationship between the personalized QOL measures and severity of dementia was investigated. Finally, the study explored the differences between countries regarding the personalized overall QOL and differences in the importance of QOL domains. This explorative one-group design study used baseline data from the MEETINGDEM study into the implementation of the Meeting Centres Support Programme in Italy, Poland and the UK. The personalized versions of the DQoL and QoL-AD were reliable, but not more valid than their standard versions. No relationship between severity of dementia and personalized QOL was found. While no differences were found between countries for the overall QOL score, some QOL domains were valued differently: people with dementia from the UK rated self-esteem, mood, physical health, energy level and the ability to do chores around the house significantly less important than people from Italy and Poland. The personalized versions of the DQoL and QoL-AD may offer dementia care practice important insights into what domains contribute most to an individual's QOL.
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Affiliation(s)
- Iris Hendriks
- Department of Psychiatry, Amsterdam UMC, Location VUmc GGZ-inGeest Dienst Onderzoek en Innovatie, Amsterdam, The Netherlands
| | - Raquel Demetrio
- Department of Psychology, University of Leiden, Wassenaarseweg, The Netherlands
| | - Franka J. M. Meiland
- Department of Psychiatry, Amsterdam UMC, Location VUmc GGZ-inGeest Dienst Onderzoek en Innovatie, Amsterdam, The Netherlands
| | - Rabih Chattat
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Dorota Szcześniak
- Department of Psychiatry, Wroclaw Medical University, Wrocław, Poland
| | | | - Teake P. Ettema
- Department of Psychiatry, Amsterdam UMC, Location VUmc GGZ-inGeest Dienst Onderzoek en Innovatie, Amsterdam, The Netherlands
| | - Shirley B. Evans
- Association for Dementia Studies, John’s Campus, University of Worcester, Worcester, UK
| | - Dawn Brooker
- Association for Dementia Studies, John’s Campus, University of Worcester, Worcester, UK
| | - Simon C. Evans
- Association for Dementia Studies, John’s Campus, University of Worcester, Worcester, UK
| | - Teresa Atkinson
- Association for Dementia Studies, John’s Campus, University of Worcester, Worcester, UK
| | | | | | - Debby L. Gerritsen
- Department of Primary and Community Care, Nijmegen Medical Centre, Radboud Alzheimer Centre, Radboud University, Nijmegen, The Netherlands
| | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam UMC, Location VUmc GGZ-inGeest Dienst Onderzoek en Innovatie, Amsterdam, The Netherlands
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Ernstsson O, Burström K, Heintz E, Mølsted Alvesson H. Reporting and valuing one's own health: a think aloud study using EQ-5D-5L, EQ VAS and a time trade-off question among patients with a chronic condition. Health Qual Life Outcomes 2020; 18:388. [PMID: 33334348 PMCID: PMC7745504 DOI: 10.1186/s12955-020-01641-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background The EQ-5D-5L, the EQ VAS, and the time trade-off (TTO) are commonly used to report and value health. Still, there is a need to better understand how these questionnaires and methods are perceived by the respondents, as well as the thoughts and motives behind their responses. The aim of this study was to increase knowledge of how individuals think and reason when reporting and valuing their own current health, using EQ-5D-5L, EQ VAS, and an open-ended TTO question. Methods Twenty patients with type 1 diabetes participated in qualitative individual think aloud interviews in Stockholm, Sweden. Participants were asked to describe their thoughts when responding to three assessments. The interviews were transcribed verbatim and analyzed using thematic analysis. Results The analysis showed that participants conducted the assessments by contextualizing and interpreting instructions, relating the questions to their own health, using different recall periods and time perspectives, and using personal, interpersonal, or normative comparators. It was challenging to reduce the experience of everyday life into a response option, and the thoughts behind the responses differed between the assessments. Before deciding on what to include, participants thought of the purpose and context of the assessments. Current health or past experiences of health were applied in the EQ-5D descriptive system and in EQ VAS, while participants focused on the future in the TTO. Thoughts about the impact on others, personal goals, and expectations on future health were more clearly integrated in the TTO assessment. All participants considered the trade-off between life years and health. However, despite the use of different comparators, the concept of ‘full health’ was found difficult to imagine or relate to. Conclusions This study provides insights as to how responses to the EQ-5D-5L, EQ VAS, and TTO assessments are complementary and where these assessments differ in adults with a chronic condition. The findings may contribute to a better understanding when interpreting the quantitative results and contribute to the literature pertaining to possible explanations for differences in health state values depending on the valuation method.
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Affiliation(s)
- Olivia Ernstsson
- QRC Research Unit, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
| | - Kristina Burström
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden.,Health Care Services, Region Stockholm, 171 77, Stockholm, Sweden
| | - Emelie Heintz
- QRC Research Unit, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Helle Mølsted Alvesson
- Health Systems and Policy, Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
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23
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Engel L, Bucholc J, Mihalopoulos C, Mulhern B, Ratcliffe J, Yates M, Hanna L. A qualitative exploration of the content and face validity of preference-based measures within the context of dementia. Health Qual Life Outcomes 2020; 18:178. [PMID: 32527264 PMCID: PMC7291594 DOI: 10.1186/s12955-020-01425-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 05/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assessing the cost-effectiveness of interventions for people with dementia, based on cost per quality-adjusted life years (QALYs) gained, requires that the measures used to derive QALYs are preference-based whilst also being valid, feasible to use, comprehensible and acceptable for people with dementia. The aim of this study was to assess the content and face validity of six preference-based measures (PBMs) within the context of dementia. METHODS Qualitative focus groups and interviews were conducted with community-dwelling individuals with mild dementia and carers of people with dementia. After exploring participants' understanding of 'quality of life' (QoL), six PBMs were assessed for content and face validity: two measures assessing health-related QoL (EQ-5D-5L and AQoL-8D); two covering broader aspects of capability wellbeing and social care-related QoL (ICECAP-O and ASCOT); and two dementia-specific QoL measures (DEMQOL-U and AD-5D). A random mix of one health-related QoL measure, one wellbeing measure, and one dementia-specific measure was explored in each session. All sessions were audiotaped and transcribed verbatim. Data were analysed thematically. RESULTS Nine individuals with mild dementia and 17 carers of people with dementia participated across 4 focus groups and 10 interviews. Participants perceived 9 broad QoL domains as relevant to them: Activity, Autonomy, Cognition, Communication, Coping, Emotions, End-of-Life, Physical Functioning, and Relationships. These domains had limited overlap with the content of the six PBMs. Assessment of face validity was summarized into eight themes: (1) ambiguous questions, (2) double -barrelled questions, (3) difficult/abstract questions, (4) judgemental/confronting questions, (5) lack of relevance and comprehensiveness, (6) response options, (7) layout/format and (8) proxy-response. There was no clear preference for one of the six measures explored; participants identified advantages and disadvantages across all measures. Although particularly designed for individuals with dementia, dementia-specific QoL measures were not always favoured over non-specific measures. CONCLUSION Given the shortcomings of PBMs identified in this study, further empirical comparative analyses are necessary to guide the selection of PBMs for future dementia research.
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Affiliation(s)
- Lidia Engel
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia.
| | - Jessica Bucholc
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Cathrine Mihalopoulos
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Mark Yates
- Ballarat Health Services, Ballarat, Victoria, Australia
| | - Lisa Hanna
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
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24
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Helter TM, Coast J, Łaszewska A, Stamm T, Simon J. Capability instruments in economic evaluations of health-related interventions: a comparative review of the literature. Qual Life Res 2020; 29:1433-1464. [PMID: 31875309 PMCID: PMC7253529 DOI: 10.1007/s11136-019-02393-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE Given increasing interest in using the capability approach for health economic evaluations and a growing literature, this paper aims to synthesise current information about the characteristics of capability instruments and their application in health economic evaluations. METHODS A systematic literature review was conducted to assess studies that contained information on the development, psychometric properties and valuation of capability instruments, or their application in economic evaluations. RESULTS The review identified 98 studies and 14 instruments for inclusion. There is some evidence on the psychometric properties of most instruments. Most papers found moderate-to-high correlation between health and capability measures, ranging between 0.41 and 0.64. ASCOT, ICECAP-A, -O and -SCM instruments have published valuation sets, most frequently developed using best-worst scaling. Thirteen instruments were originally developed in English and one in Portuguese; however, some translations to other languages are available. Ten economic evaluations using capability instruments were identified. The presentation of results show a lack of consensus regarding the most appropriate way to use capability instruments in economic evaluations with discussion about capability-adjusted life years (CALYs), years of capability equivalence and the trade-off between maximisation of capability versus sufficient capability. CONCLUSION There has been increasing interest in applying the capability-based approach in health economic evaluations, but methodological and conceptual issues remain. There is still a need for direct comparison of the different capability instruments and for clear guidance on when and how they should be used in economic evaluations.
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Affiliation(s)
- Timea Mariann Helter
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria.
| | - Joanna Coast
- Health Economics Bristol, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
| | - Agata Łaszewska
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
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25
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Mitchell PM, Caskey FJ, Scott J, Sanghera S, Coast J. Response process validity of three patient reported outcome measures for people requiring kidney care: a think-aloud study using the EQ-5D-5L, ICECAP-A and ICECAP-O. BMJ Open 2020; 10:e034569. [PMID: 32414822 PMCID: PMC7232621 DOI: 10.1136/bmjopen-2019-034569] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/10/2020] [Accepted: 02/27/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To determine the response process validity, feasibility of completion, acceptability and preferences for three patient-reported outcome measures that could be used in economic evaluation-the EQ-5D-5L, ICECAP-A and ICECAP-O-in people requiring kidney care. DESIGN Participants were asked to 'think-aloud' while completing the EQ-5D-5L, ICECAP-A and ICECAP-O, followed by a semistructured interview. Five raters identified errors or struggles in completing the measures from the think-aloud component of the transcripts. Patient preferences for measures were extracted from the semistructured interview. SETTING Eligible patients were identified through a large UK secondary care renal centre. PARTICIPANTS In total, 30 participants were included in the study, consisting of patients attending renal outpatients for chronic kidney disease (n=18), with a functioning kidney transplant (n=6) and receiving haemodialysis (n=6). RESULTS Participants had few errors and struggles in completing the EQ-5D-5L (11% error rate, 3% struggle rate), ICECAP-A (2% error rate, 2% struggle rate) and ICECAP-O (4% error rate, 3% struggle rate). The main errors with the EQ-5D-5L were judgements that did not comply with the 'your health today' instruction. Comprehension errors were most prominent on ICECAP-O. Judgement errors were the only errors reported on ICECAP-A. Although the EQ-5D-5L had slightly more errors and struggles, it was the measure most preferred, with participants able to make a clearer link with EQ-5D-5L and their health condition. CONCLUSIONS The EQ-5D-5L, ICECAP-A and ICECAP-O are feasible for people requiring kidney care to complete and can be included in studies conducting economic evaluations of kidney care interventions. Further research is required to assess how health (eg, EQ-5D) and capability (eg, ICECAP) measures can be included in an economic evaluation simultaneously, as well as what ICECAP measure(s) to include when patient groups straddle the age ranges for ICECAP-A (18 years and older) and ICECAP-O (65 years and older).
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Affiliation(s)
- Paul Mark Mitchell
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, UK
| | - Fergus John Caskey
- Population Health Sciences, University of Bristol, Bristol, UK
- UK Renal Registry, Southmead Hospital Bristol, Bristol, UK
- North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Jemima Scott
- UK Renal Registry, Southmead Hospital Bristol, Bristol, UK
- North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Sabina Sanghera
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, UK
| | - Joanna Coast
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, UK
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Cardona B, Fine M, Riley S. Meeting the challenges of measuring outcomes of home care programs: The Australian Community Outcomes Measurement (ACCOM) tool. Home Health Care Serv Q 2020; 39:141-153. [PMID: 32394819 DOI: 10.1080/01621424.2020.1759477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Measuring the impact of care delivered at home for frail older people is a complex task given many confounding variables that may impact on the ability of service providers to identify the direct impact of their programs on their clients' well-being and quality of life. The recent publication of the 2018 Wellness and Reablement Report Outcomes indicated that organizations lack formal processes to measure the impact of their programs on service users. There are therefore limited data exits on measuring outcomes and the performance of the ACCOM tool in the real world. Knowledge of a strong causal relationship between services provided and outcomes enables confidence in assuming the care provided was largely responsible for the outcome achieved. This paper will reflect on the experiences of one service provider in Brisbane, in implementing the Australian Community Care Outcomes Measurement (ACCOM) tool to measure and demonstrate the impact of their programs.
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Affiliation(s)
- Beatriz Cardona
- Centre for Primary Health Care and Equity, University of NSW , Sydney, Australia
| | - Michael Fine
- Sociology, Macquarie University , Sydney, Australia
| | - Shaun Riley
- Jubilee Community Care , Brisbane, Australia
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Development of Japanese utility weights for the Adult Social Care Outcomes Toolkit (ASCOT) SCT4. Qual Life Res 2019; 29:253-263. [PMID: 31485915 PMCID: PMC6962125 DOI: 10.1007/s11136-019-02287-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2019] [Indexed: 11/05/2022]
Abstract
Purpose In developed countries, progressive rapid aging is increasing the need for social care. This study aimed to determine Japanese utility weights for the Adult Social Care Outcomes Toolkit (ASCOT) four-level self-completion questionnaire (SCT4). Methods We recruited 1050 Japanese respondents from the general population, stratified by sex and age, from five major cities. In the best–worst scaling (BWS) phase, respondents ranked various social care-related quality of life (SCRQoL) states as “best,” “worst,” “second-best,” or “second-worst,” as per the ASCOT. Then, respondents were asked to evaluate eight different SCRQOL states by composite time-trade off (cTTO). A mixed logit model was used to analyze BWS data. The association between cTTO and latent BWS scores was used to estimate a scoring formula that would convert BWS scores to SC-QALY (social care quality-adjusted life year) scores. Results Japanese BWS weightings for ASCOT-SCT4 were successfully estimated and found generally consistent with the UK utility weights. However, coefficients on level 3 of “Control over daily life” and “Occupation” domains differed markedly between Japan and the UK. The worst Japanese SCRQoL state was lower than that for the UK, as Japanese cTTO results showed more negative valuations. In general, Japanese SC-QALY score (for more than 90% of health states) was lower than that for the UK. Conclusions We successfully obtained Japanese utility weights for ASCOT SCT4. This will contribute to the measurement and understanding of social care outcomes. Electronic supplementary material The online version of this article (10.1007/s11136-019-02287-6) contains supplementary material, which is available to authorized users.
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28
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Proud L, McLoughlin C, Kinghorn P. ICECAP-O, the current state of play: a systematic review of studies reporting the psychometric properties and use of the instrument over the decade since its publication. Qual Life Res 2019; 28:1429-1439. [PMID: 30666550 PMCID: PMC6522451 DOI: 10.1007/s11136-019-02114-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE A paper reporting the development of the ICECAP-O was published in 2006. Since then, there has been increasing interest in the use of capability-based measures within health economics and the ICECAP-O has been suggested for use in economic evaluation by decision-making bodies in the Netherlands and UK. METHODS A systematic review of studies published between January 2006 and October 2018 which have assessed the psychometric properties of ICECAP-O or utilised the measure within economic evaluation. RESULTS Twenty-four studies explored the psychometric properties of ICECAP-O and 21 have utilised the measure within economic evaluation; one study reported psychometric properties as well as utilising the measure within economic evaluation. The ICECAP-O has good construct validity and responsiveness, but there is evidence of some issues relating to content validity. In the context of economic evaluation, the ICECAP-O has, to date, mainly been included as a secondary economic measure and the reporting of results is brief with minimal detail and often no discussion. Five of the economic evaluation studies combined scores from ICECAP-O with time, but each used different terminology to describe this result. CONCLUSION Focus, in terms of publications, appears to have shifted now from assessment of psychometric properties to the utilisation of the ICECAP-O within economic evaluation. Further research is needed with respect to a decision-rule for the ICECAP measures. This additional research should also guide users in terms of appropriate analysis, terminology and presentation of results, which are in-keeping with the conceptual framework underpinning the ICECAP-O.
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Affiliation(s)
- Louise Proud
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, UK
| | - Carol McLoughlin
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, UK
| | - Philip Kinghorn
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, UK.
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Mulhern B, Norman R, De Abreu Lourenco R, Malley J, Street D, Viney R. Investigating the relative value of health and social care related quality of life using a discrete choice experiment. Soc Sci Med 2019; 233:28-37. [PMID: 31153085 DOI: 10.1016/j.socscimed.2019.05.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 05/02/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
A key outcome in the evaluation of health technologies is the quality adjusted life year (QALY) which is often estimated using health measures such as the EuroQol instruments (EQ-5D-3L and EQ-5D-5L). The impacts of many interventions extend beyond a narrow definition of health to include non-health impacts such as social care related dimensions of quality of life (QoL). This means that there are circumstances where the QALY does not capture the full value of an intervention. In response to this, instruments with a wider measurement framework, such as the Adult Social Care Outcomes Toolkit (ASCOT), which measures social care related QoL, have been developed. Given the range of instruments available, it is important that decision-makers have tools to assess value for money comprehensively and consistently. To date, preference elicitation of different aspects of QoL combined within the same valuation procedure has not been tested. We investigate the relationship between health and social care aspects of QoL when assessed jointly by combining EQ-5D-5L and ASCOT in an online discrete choice experiment (DCE). In July 2016, 975 respondents recruited from internet panels completed 15 choice sets from an underlying design of 300. Conditional logit regression was used to estimate coefficient decrements for each attribute and examine their relative magnitude. Latent class and mixed logit modelling were used to understand preference heterogeneity. The results suggest trading across health and social care aspects indicated by coefficient estimates of differing magnitude. Dimensions with the largest disutility include four from EQ-5D-5L and one from ASCOT. There is evidence of preference heterogeneity at more severe dimension levels. We have used an established method to test the joint valuation of concepts measuring different aspects of QoL. The results have implications for the aspects of QoL that are included in QALY estimation and used in resource allocation decision-making.
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Affiliation(s)
- Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, 1 - 59 Quay St, Haymarket, Sydney, NSW, 2000, Australia.
| | - Richard Norman
- School of Public Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, 1 - 59 Quay St, Haymarket, Sydney, NSW, 2000, Australia
| | - Juliette Malley
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton St, London, WC2A 2AE, UK
| | - Deborah Street
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, 1 - 59 Quay St, Haymarket, Sydney, NSW, 2000, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, 1 - 59 Quay St, Haymarket, Sydney, NSW, 2000, Australia
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30
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Adolescent and young adult cancer survivors' perceptions of participating in a survey – Ethical and methodological considerations. Eur J Oncol Nurs 2019; 39:55-61. [DOI: 10.1016/j.ejon.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/30/2019] [Accepted: 02/01/2019] [Indexed: 11/20/2022]
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Towers AM, Palmer S, Smith N, Collins G, Allan S. A cross-sectional study exploring the relationship between regulator quality ratings and care home residents' quality of life in England. Health Qual Life Outcomes 2019; 17:22. [PMID: 30704482 PMCID: PMC6357453 DOI: 10.1186/s12955-019-1093-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/15/2019] [Indexed: 08/19/2023] Open
Abstract
Background The quality of life of people receiving health and social care is an important indicator of service quality, but the relationship between patient experience and outcomes and regulator quality ratings in England is unknown. In 2013, the health and social care regulator in England, the Care Quality Commission (CQC), introduced a new ratings system and by February 2017, all social care services were inspected and awarded new quality ratings (outstanding, good, requires improvement and inadequate). This study aimed to explore whether quality ratings were associated with residents’ quality of life, controlling for confounding variables. Methods We conducted a nested, cross-sectional study, collecting social care-related quality of life (SCRQoL) data for 293 older care home residents in 34 care homes (20 nursing and 14 residential) in the South East of England. CQC ratings and other resident and home-level variables were also collected for the analysis. Multilevel modelling explored whether residents’ social care-related quality of life (SCRQoL) was associated with regulator ratings, controlling for confounding variables. Results Outstanding and good homes were collapsed into one category and compared with homes requiring improvement. Nationally, only 2 % of care homes for older people are rated as inadequate and it was not possible to capture sufficient numbers for the analysis. We recruited one but it was re-inspected during the fieldwork period and its rating changed to requires improvement. The random intercept multilevel model, which accounted for 16.93% of the differences in SCRQoL within homes and 69.80% between, indicated that better SCRQoL was significantly associated with being female, better functioning, no dementia diagnosis, fewer communication difficulties, and living in a care home rated as outstanding/good by CQC. Size of home and registration category were not significant predictors. Conclusions This study found evidence that quality ratings are associated with residents’ SCRQoL. As well as aiming to improve quality and ensure minimum standards, quality ratings have the potential to inform user choice and help the public compare care homes based on quality. Future research to establish the generalisability and replicability of the results is required.
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Affiliation(s)
- Ann-Marie Towers
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK.
| | - Sinead Palmer
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK
| | - Nick Smith
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK
| | - Grace Collins
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK
| | - Stephen Allan
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK
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Botes R, Vermeulen KM, Gerber AM, Ranchor AV, Buskens E. Health-related quality of life and well-being health state values among Dutch oldest old. Patient Prefer Adherence 2019; 13:721-728. [PMID: 31190754 PMCID: PMC6522649 DOI: 10.2147/ppa.s193171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/23/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Valuing hypothetical health states is a demanding personal process, since it involves the psychological evaluation of hypothetical health states. It seems plausible that elderly individuals will value hypothetical health states differently than the general population. It is, however, important to understand the psychological division that oldest old subgroups construct between acceptable and unacceptable health states. This information can produce important evidence regarding well-being and disability conceptualization. Objective: To investigate how Dutch oldest old, conceptualize health-related quality of life health states when compared to well-being health states. In addition, we aim to compare subgroups, based on dependency classification. Methods: Ninety-nine elderly living in the Groningen, Hoogeveen and Veendam areas of the Netherlands participated in the study. Respondents were classified into three groups based on dependency levels. The respondents were asked to value hypothetical health states, a generic preference-based HRQoL and a well-being instrument, using a visual analog scale. Results: All three groups ranked the same health states, from both questionnaires, below the average across the health states. The health-related quality of life health states was consistently ranked lower than the current well-being health states. Conclusions: Health state valuations performed by the oldest old indicate that conceptually, respondents view below average health-related and well-being health states as undesirable. The results indicated that the oldest old do view deficits in health-related health states as more important than deficits in well-being health states. Since the oldest old performed the valuations, focused interventions to improve below average health-related outcomes might be the most cost-effective way to increase oldest old well-being outcomes.
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Affiliation(s)
- Riaan Botes
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, 9700 RB, The Netherlands
- Correspondence: Riaan BotesDepartment of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, Groningen9700 RB, The NetherlandsTel +312 779 359 7351Email
| | - Karin M Vermeulen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, 9700 RB, The Netherlands
| | - Anthonie M Gerber
- Department of Basic Medical Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, 9300, South Africa
| | - Adelita V Ranchor
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, 9700 AD, The Netherlands
| | - Erik Buskens
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, 9700 RB, The Netherlands
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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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Whalley D, Globe G, Crawford R, Doward L, Tafesse E, Brazier J, Price D. Is the EQ-5D fit for purpose in asthma? Acceptability and content validity from the patient perspective. Health Qual Life Outcomes 2018; 16:160. [PMID: 30075729 PMCID: PMC6090889 DOI: 10.1186/s12955-018-0970-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/09/2018] [Indexed: 12/24/2022] Open
Abstract
Background The increasing emphasis on patient-reported outcomes in health care decision making has prompted greater rigor in the evidence to support the instruments used. Acceptability and content validity are important properties of any measure to ensure it assesses the relevant aspects of the target concept. The purpose of this study was to evaluate the acceptability and content validity of the EQ-5D 5-Level (EQ-5D-5L) to assess the impact of asthma on patients’ lives. Methods Qualitative interviews were conducted with 40 adults with asthma in the United Kingdom. The first 25 interviews used cognitive-debriefing methods to assess the relevance and acceptability of the EQ-5D-5L and two asthma-specific measures for comparison: an asthma-specific, preference-based measure (the Asthma Quality of Life Utility Index–5 Dimensions) and an Asthma Symptom Diary. The final 15 interviews combined concept elicitation to identify patient-perceived asthma impact, and cognitive debriefing to assess relevance and acceptability of the EQ-5D-5L and the Asthma Symptom Diary. Cognitive-debriefing feedback on the content of the measures was collated and summarized descriptively. The concept-elicitation data were analyzed thematically. Results Participants were aged 20 to 57 years and 62.5% were female. Although some participants expressed positive opinions on aspects of the EQ-5D-5L, only the usual activities dimension was consistently considered relevant to participants’ asthma experiences. The mobility and self-care dimensions prompted strong negative reactions from some participants. Variations in interpretation of the mobility dimension and difficulties with multiple concepts in the pain/discomfort and anxiety/depression dimensions also were noted. Concepts reported by participants as missing included environmental triggers, asthma symptoms, emotions, and sleep. The EQ-5D-5L was the least preferred measure to describe the impact of asthma on participants’ lives. Participants reported shortness of breath and impact on activities as especially salient issues. Conclusions The content of the EQ-5D-5L was poorly aligned with the patient-perceived impact of asthma, and the measure failed to meet basic standards for acceptability and content validity as a measure to assess the impact of asthma from the patient perspective. The shortcomings identified raise concerns regarding the appropriateness of the EQ-5D in asthma and further evaluation is warranted.
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Affiliation(s)
| | - Gary Globe
- Amgen Inc., Thousand Oaks, CA, 91320, USA
| | | | | | | | - John Brazier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - David Price
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Uittenbroek RJ, van Asselt ADI, Spoorenberg SLW, Kremer HPH, Wynia K, Reijneveld SA. Integrated and Person-Centered Care for Community-Living Older Adults: A Cost-Effectiveness Study. Health Serv Res 2018; 53:3471-3494. [PMID: 29573398 DOI: 10.1111/1475-6773.12853] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To assess the cost-effectiveness of Embrace, an integrated primary care service for older adults. DATA SOURCES Care and support claims from health care insurers, long-term care administration, and municipalities for enrolled older adults between 2011 and 2013. STUDY DESIGN A total of 1,456 older adults, listed with 15 general practitioners practices in the Netherlands, were stratified into risk profiles ("Robust," "Frail," and "Complex care needs") and randomized to Embrace or care-as-usual groups. Incremental costs were calculated per quality-adjusted life year, per day able to age in place, and per percentage point risk profile improvement. PRINCIPAL FINDINGS Total average costs were higher for Embrace compared to care-as-usual. Differences in health-associated outcomes were small and not statistically significant. Probabilities that Embrace is cost-effective were below 80 percent, except for "risk profile improvements" within risk profile "Complex care needs." Complete case analysis resulted in smaller differences in total average costs across conditions and differences in health-associated outcomes remained small. CONCLUSIONS According to current standards, Embrace is not considered cost effective after 12 months. However, it could be considered worthwhile in terms of "risk profile improvements" for older adults with "Complex care needs," if society is willing to invest substantially.
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Affiliation(s)
- Ronald J Uittenbroek
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Antoinette D I van Asselt
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Sophie L W Spoorenberg
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hubertus P H Kremer
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Klaske Wynia
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Evaluating the quality of care received in long-term care facilities from a consumer perspective: development and construct validity of the Consumer Choice Index – Six Dimension instrument. AGEING & SOCIETY 2017. [DOI: 10.1017/s0144686x17000861] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTThe Consumer Choice Index – Six Dimension (CCI-6D) is a new instrument designed specifically to evaluate the quality of care received in long-term care from a consumer perspective. This study aims to demonstrate the construct validity of the CCI-6D. Older residents living in long-term care facilities and proxy family carers (where severely impaired cognition precluded resident consent) participated as consumers of long-term care. Data collected included the CCI-6D instrument, quality of life, physical function and characteristics of the care facility. Relationships between these variables and the CCI-6D dimensions were assessed and analysed through chi-squared and Kruskal–Wallis tests to assess the construct validity of each dimension. Of 430 eligible consumers, a total of 253 completed the questionnaire, of whom 68 (27%) were residents and 185 (73%) were informal carer proxy participants. There was strong evidence of construct validity of the dimensions relating to adequacy of individual care time, access to outside and gardens, access to meaningful activities and flexibility of care. There was more moderate evidence of validity of the home-like own room and shared spaces items, which may be in part due to difficulty in identifying strong discriminatory variables for comparison with these items. The results also indicate a strong association between ‘processes’ of care delivery (as measured by the CCI-6D) and quality of life of care recipients.
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Vos-Vromans D, Evers S, Huijnen I, Köke A, Hitters M, Rijnders N, Pont M, Knottnerus A, Smeets R. Economic evaluation of multidisciplinary rehabilitation treatment versus cognitive behavioural therapy for patients with chronic fatigue syndrome: A randomized controlled trial. PLoS One 2017; 12:e0177260. [PMID: 28574985 PMCID: PMC5456034 DOI: 10.1371/journal.pone.0177260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 04/25/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A multi-centre RCT has shown that multidisciplinary rehabilitation treatment (MRT) is more effective in reducing fatigue over the long-term in comparison with cognitive behavioural therapy (CBT) for patients with chronic fatigue syndrome (CFS), but evidence on its cost-effectiveness is lacking. AIM To compare the cost-effectiveness of MRT versus CBT for patients with CFS from a societal perspective. METHODS A multi-centre randomized controlled trial comparing MRT with CBT was conducted among 122 patients with CFS diagnosed using the 1994 criteria of the Centers for Disease Control and Prevention and aged between 18 and 60 years. The societal costs (healthcare costs, patient and family costs, and costs for loss of productivity), fatigue severity, quality of life, quality-adjusted life-year (QALY), and cost-effectiveness ratios (ICERs) were measured over a follow-up period of one year. The main outcome of the cost-effectiveness analysis was fatigue measured by the Checklist Individual Strength (CIS). The main outcome of the cost-utility analysis was the QALY based on the EuroQol-5D-3L utilities. Sensitivity analyses were performed, and uncertainty was calculated using the cost-effectiveness acceptability curves and cost-effectiveness planes. RESULTS The data of 109 patients (57 MRT and 52 CBT) were analyzed. MRT was significantly more effective in reducing fatigue at 52 weeks. The mean difference in QALY between the treatments was not significant (0.09, 95% CI: -0.02 to 0.19). The total societal costs were significantly higher for patients allocated to MRT (a difference of €5,389, 95% CI: 2,488 to 8,091). MRT has a high probability of being the most cost effective, using fatigue as the primary outcome. The ICER is €856 per unit of the CIS fatigue subscale. The results of the cost-utility analysis, using the QALY, indicate that the CBT had a higher likelihood of being more cost-effective. CONCLUSIONS The probability of being more cost-effective is higher for MRT when using fatigue as primary outcome variable. Using QALY as the primary outcome, CBT has the highest probability of being more cost-effective. TRIAL REGISTRATION ISRCTN77567702.
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Affiliation(s)
| | - Silvia Evers
- Department of Health Services Research, Research School CAPHRI Maastricht University, Maastricht, The Netherlands.,Trimbos Institute, National Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ivan Huijnen
- Department of Rehabilitation Medicine, Research School CAPHRI Maastricht University, Maastricht, The Netherlands.,Department of Rehabilitation Medicine, Academic Hospital Maastricht, Maastricht, The Netherlands.,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Albère Köke
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Minou Hitters
- Libra Rehabilitation and Audiology, Eindhoven, The Netherlands
| | | | - Menno Pont
- Reade Centre of Rheumatology and Rehabilitation, Amsterdam, The Netherlands
| | - André Knottnerus
- Department of General Practice, Research School CAPHRI Maastricht University, Maastricht, The Netherlands
| | - Rob Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI Maastricht University, Maastricht, The Netherlands.,Department of Rehabilitation Medicine, Academic Hospital Maastricht, Maastricht, The Netherlands.,Libra Rehabilitation and Audiology, Eindhoven, The Netherlands
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Towers AM, Smith N, Palmer S, Welch E, Netten A. The acceptability and feasibility of using the Adult Social Care Outcomes Toolkit (ASCOT) to inform practice in care homes. BMC Health Serv Res 2016; 16:523. [PMID: 27682625 PMCID: PMC5041329 DOI: 10.1186/s12913-016-1763-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 09/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Adult Social Care Outcomes Toolkit (ASCOT) measures social care related quality of life (SCRQoL) and can be used to measure outcomes and demonstrate impact across different social care settings. This exploratory study built on previous work by collecting new inter-rater reliability data on the mixed-methods version of the toolkit and exploring how it might be used to inform practice in four case study homes. METHOD We worked with two care home providers to agree an in-depth study collecting SCRQoL data in four case-study homes. Data was collected about residents' age, ethnicity, cognitive impairment, ability to perform activities of daily living and SCRQoL in the four homes. Feedback sessions with staff and managers were held in the homes two weeks after baseline and follow-up data collected three months later. Interviews with managers explored their views of the feedback and recorded any changes that had been made because of it. RESULTS Participant recruitment was challenging, despite working in partnership with the homes. Resident response rates ranged from 23 to 54 % with 58 residents from four care homes taking part in the research. 53 % lacked capacity to consent. Inter-rater reliability for the ASCOT ratings of SCRQoL were good at time one (IRR = 0.72) and excellent at time two (IRR = 0.76). During the study, residents' ability to perform activities of daily living declined significantly (z = -2.67, p < .01), as did their expected needs in the absence of services (z = -2.41, p < .05). Despite these rapid declines in functionings, residents' current SCRQoL declined slightly but not significantly (Z = -1.49, p = .14). Staff responded positively to the feedback given and managers reported implementing changes in practice because of it. CONCLUSION This exploratory study faced many challenges in the recruitment of residents, many of whom were cognitively impaired. Nevertheless, without a mixed-methods approach many of the residents living in the care homes would have been excluded from the research altogether or had their views represented only by a representative or proxy. The value of the mixed-methods toolkit and its potential for use by providers is discussed.
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Affiliation(s)
- Ann-Marie Towers
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK.
| | - Nick Smith
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK
| | - Sinead Palmer
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK
| | - Elizabeth Welch
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK
| | - Ann Netten
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, CT2 7NF, UK
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van de Wetering EJ, van Exel NJA, Brouwer WBF. Health or Happiness? A Note on Trading Off Health and Happiness in Rationing Decisions. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:552-557. [PMID: 27565272 DOI: 10.1016/j.jval.2016.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Economic evaluations typically value the effects of an intervention in terms of quality-adjusted life-years, which combine length and health-related quality of life. It has been suggested that economic evaluations should incorporate broader outcomes than health-related quality of life. Broader well-being, for instance measured as happiness, could be a better measure of the overall welfare effects in patients because of treatment. An underexplored question is whether and how people trade off information on health and broader outcomes from treatment in rationing decisions. OBJECTIVES This article presents the results of a first experiment aimed at exploring such trade-offs between health and happiness. METHODS We used a Web-based questionnaire in a representative sample of the public from the Netherlands (N = 1015). People made choices between two groups of patients differing in terms of their health and happiness levels before treatment and gains from treatment. RESULTS The results showed that about half the respondents were willing to discriminate between patient groups on the basis of their health and happiness levels before and after treatment. In the trader group, health gains were considered somewhat more important than happiness gains. CONCLUSIONS Our findings suggest that both health and happiness levels of patients may play a role in priority setting.
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Affiliation(s)
- E J van de Wetering
- Institute of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - N J A van Exel
- Institute of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus School of Economics, Erasmus University Rotterdam, The Netherlands
| | - W B F Brouwer
- Institute of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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Taylor N, Hogden E, Clay-Williams R, Li Z, Lawton R, Braithwaite J. Older, vulnerable patient view: a pilot and feasibility study of the patient measure of safety (PMOS) with patients in Australia. BMJ Open 2016; 6:e011069. [PMID: 27279478 PMCID: PMC4908893 DOI: 10.1136/bmjopen-2016-011069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The UK-developed patient measure of safety (PMOS) is a validated tool which captures patient perceptions of safety in hospitals. We aimed (1) to investigate the extent to which the PMOS is appropriate for use with stroke, acute myocardial infarction (AMI) and hip fracture patients in Australian hospitals and (2) to pilot the PMOS for use in a large-scale, national study 'Deepening our Understanding of Quality in Australia' (DUQuA). PARTICIPANTS Stroke, AMI and hip fracture patients (n=34) receiving care in 3 wards in 1 large hospital. METHODS 2 phases were conducted. First, a 'think aloud' study was used to determine the validity of PMOS with this population in an international setting, and to make amendments based on patient feedback. The second phase tested the revised measure to establish the internal consistency reliability of the revised subscales, and piloted the recruitment and administration processes to ensure feasibility of the PMOS for use in DUQuA. RESULTS Of the 43 questions in the PMOS, 13 (30%) were amended based on issues patients highlighted for improvement in phase 1. In phase 2, a total of 34 patients were approached and 29 included, with a mean age of 71.3 years (SD=16.39). Internal consistency reliability was established using interitem correlation and Cronbach's α for all but 1 subscale. The most and least favourably rated aspects of safety differed between the 3 wards. A study log was categorised into 10 key feasibility factors, including liaising with wards to understand operational procedures and identify patterns of patient discharge. CONCLUSIONS Capturing patient perceptions of care is crucial in improving patient safety. The revised PMOS is appropriate for use with vulnerable older adult groups. The findings from this study have informed key decisions made for the deployment of this measure as part of the DUQuA study.
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Affiliation(s)
- Natalie Taylor
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Emily Hogden
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Zhicheng Li
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Rebecca Lawton
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
- Institute of Psychological Sciences, University of Leeds, Leeds, UK
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Bulamu NB, Kaambwa B, Ratcliffe J. A systematic review of instruments for measuring outcomes in economic evaluation within aged care. Health Qual Life Outcomes 2015; 13:179. [PMID: 26553129 PMCID: PMC4640110 DOI: 10.1186/s12955-015-0372-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/22/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND This paper describes the methods and results of a systematic review to identify instruments used to measure quality of life outcomes in older people. The primary focus of the review was to identify instruments suitable for application with older people within economic evaluations conducted in the aged care sector. METHODS Online databases searched were PubMed, Medline, Scopus, and Web of Science, PsycInfo, CINAHL, Embase and Informit. Studies that met the following criteria were included: 1) study population exclusively above 65 years of age 2) measured health status, health related quality of life or quality of life outcomes more broadly through use of an instrument developed for this purpose, 3) used a generic preference based instrument or an older person specific preference based or non-preference based instrument or both, and 4) published in journals in the English language after 2000. RESULTS The most commonly applied generic preference based instrument in both the community and residential aged care context was the EuroQol - 5 Dimensions (EQ-5D), followed by the Adult Social Care Outcomes Toolkit (ASCOT) and the Health Utilities Index (HUI2/3). The most widely applied older person specific instrument was the ICEpop CAPability measure for Older people (ICECAP-O) in both community and residential aged care. CONCLUSION In the absence of an ideal instrument for incorporating into economic evaluations in the aged care sector, this review recommends the use of a generic preference based measure of health related quality of life such as the EQ-5D to obtain quality adjusted life years, in combination with an instrument that has a broader quality of life focus like the ASCOT, which was designed specifically for evaluating interventions in social care or the ICECAP-O, a capability measure for older people.
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Affiliation(s)
- Norma B Bulamu
- Flinders Health Economics Group, School of Medicine, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Australia.
| | - Billingsley Kaambwa
- Flinders Health Economics Group, School of Medicine, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Australia.
| | - Julie Ratcliffe
- Flinders Health Economics Group, School of Medicine, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Australia.
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