A DISCRETE CHOICE EXPERIMENT IN DIFFERENT HEALTH STATES- PATIENT PREFERENCES FOR PATIENT-CENTERED HEALTH CARE DELIVERY SYSTEMS

Author(s)

Mühlbacher A1, Bethge S1, Schulman K21Hochschule Neubrandenburg, Neubrandenburg, Germany, 2Duke Clinical Research Institute, Durham, NC, USA

OBJECTIVES: Patient-centered care is seen as a critical factor in a high-performance health care system. We considered a randomized decision-situation in which the available information is given by three hypothetical health states (information sets: consider you have been diagnosed with diabetes, lung cancer, or based on the status quo of the respondent). METHODS: Within a discrete-choice experiment (DCE) 21 characteristics of a healthcare delivery system are being used to construct 4 DCEs based on thematic mapping (patient-involvement; point of care; personnel; organization). Each DCE included six attributes with three specific levels. Furthermore respondents were randomly assigned and asked to make their decisions based on different information sets. RESULTS: For the N=3900 respondents the feature “out-of-pocket costs” was the important attribute across all 4 DCEs (DCE-1 coefficient, 0,6550; DCE-2 coefficient, 0,8624; DCE-3 coefficient, 0,6991; DCE-4 coefficient, 0,7926). Only “multidisciplinary care” in DCE-3 (Personnel) scored higher than cost with a coefficient of 0,7081. In DCE1 regarding patient-involvement, “trust and respect” (0,6187) and in DCE 2 addressing preferences at the point of care, “shared-decision making” (0,7125) were of greatest importance. In DCE 4 the attribute “treatment guidelines” (0,4682) was of high importance. The analysis showed that the relevance of the “out-of-pocket cost” changed when respondents were asked to consider their responses in the context of diabetes or lung cancer diagnosis (status quo: 0.6749; diabetes: 0.81145; lung cancer: 0.50431). Furthermore, the feature “trust and respect” (status quo: 0.70338; diabetes: 0.65555; lung cancer: 0.6369) was also less valuable when participants assumed a worse health state. CONCLUSIONS: The study aimed to close the gap between simplistic representations of patient preferences in today’s health care systems and the complexity of actual patient decision-making processes by using the explanatory power of DCEs. Understanding how patients and stakeholders perceive and value different aspects of coordinated care is vital to the optimal design and evaluation of programs.

Conference/Value in Health Info

2012-06, ISPOR 2012, Washington, D.C., USA

Value in Health, Vol. 15, No. 4 (June 2012)

Code

PIH36

Topic

Patient-Centered Research

Topic Subcategory

Adherence, Persistence, & Compliance

Disease

Pediatrics, Reproductive and Sexual Health, Respiratory-Related Disorders

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