Outcomes of social care for adults: developing a preference-weighted measure
Outcomes of social care for adults: developing a preference-weighted measure
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DOI：
10.3310/hta16160
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发表时间：
2012-03-01
影响因子：
3.6
通讯作者：
Wall, B.
中科院分区：
文献类型：
--
作者：
Netten, A.;Burge, P.;Wall, B.
目的：本研究的目的是制定一种社会关怀结果的衡量标准，相当于健康领域的质量调整生命年 (QALY)，可用于多种情况。 设计：该项目借鉴了之前开发成人社会关怀成果工具包和国家成人社会关怀调查的并行工作。我们开发并测试了一个旨在反映服务使用者的社会护理相关生活质量（SCRQoL）的工具，并对来自不同用户群体的 30 名服务使用者和 300 名老年家庭护理服务使用者进行了测试。与此同时，我们探索了离散选择实验 (DCE) 和最佳最差缩放 (BWS) 方法来诱导 300 名普通人群的偏好，并与服务用户进行认知测试。我们还使用 SCRQoL 属性对普通人群进行了计算机辅助时间权衡 (TTO) 练习的认知测试。第二阶段，使用最终确定的工具，对 500 名普通人群进行了 BWS 访谈，对其中 126 名受访者进行了后续样本访谈，BWS 对使用设备服务的 458 名受访者进行了访谈。 主要结果指标：最终指标有八个领域：个人清洁和舒适、住宿清洁和舒适、饮食、安全、社会参与和介入、职业、对日常生活的控制和尊严。除了测量当前的 SCRQoL 之外，该工具还包括一些问题，用于确定服务用户在没有服务的情况下对其“预期”SCRQoL 的看法。一个人当前和“预期”SCRQoL 之间的差异提供了服务影响的指标。结果：有充分的证据证明描述系统的有效性以及当前、预期和 SCRQoL 增益量表的有效性。 DCE 和 BWS 方法产生了类似的结果，并且一旦介绍清楚，服务用户就能够理解。 BWS 被用于主要赛段，因为它具有技术和认知优势。 TTO 的计算机辅助方法效果良好，受访者认为问题可以接受且可以理解。服务使用者与一般人群的偏好并无实质性差异。关键领域是对日常生活的控制，所有模型中都强烈估计了最低和最高水平。在考虑到可观察到的异质性后，服务用户的偏好似乎与他们自己的 SCRQoL 的相关性比与一般人群的相关性更为密切。结果与之前研究的结果一致，使得最终模型能够基于 1000 名普通人群的偏好。基于 TTO 和 BWS 值之间关系的公式针对社会护理 QALY 进行了估算，其中“0”相当于“死亡”，“1”相当于“理想”SCRQoL 状态。人口成员的 SCRQoL 明显高于服务使用者。结论：尽管需要进一步的工作，特别是为非正式护理人员制定等效的衡量标准并探索与健康 QALY 的联系，但该衡量标准具有相当大的潜力。取得了许多方法上的进步，包括在社会护理环境中首次应用 TTO 以及使用 BWS 来确定服务用户偏好。
Objective: The aim of this study was to develop a measure of social care outcome, an equivalent to the quality-adjusted life year (QALY) in health, which could be used in a range of circumstances.Design: The project drew on previous and parallel work developing the Adult Social Care Outcome Toolkit and the national Adult Social Care Survey. We developed and tested an instrument designed to reflect service users' social care-related quality of life (SCRQoL) and tested it with 30 service users from a variety of user groups and 300 older home care service users. In parallel, we explored discrete choice experiment (DCE) and best worst scaling (BWS) approaches to preference elicitation with 300 members of the general population, and cognitively tested these with service users. We also cognitively tested a computer-aided time trade-off (TTO) exercise using SCRQoL attributes with members of the general population. In the second phase, using the finalised instruments, BWS interviews were conducted with 500 members of the general population, TTO interviews with a follow-up sample of 126 of these respondents, and BWS interviews with 458 people using equipment services.Main outcome measures: The final measure had eight domains: personal cleanliness and comfort, accommodation cleanliness and comfort, food and drink, safety, social participation and involvement, occupation, control over daily life and dignity. In addition to measuring current SCRQoL, the instrument includes questions used to establish service users' views of their 'expected' SCRQoL in the absence of services. The difference between a person's current and 'expected' SCRQoL provides an indicator of service impact.Results: There was good evidence for the validity of the descriptive system and the validity of the current, expected and SCRQoL gain scales. The DCE and BWS approaches yielded similar results and, once introductions made clear, were understood by service users. BWS was used for the main stages, as it had technical and cognitive advantages. The computer-aided approach to TTO worked well, and respondents found questions acceptable and understandable. There were no substantive differences in the preferences of service users and the general population. The key domain was control over daily life, with the lowest and highest levels strongly estimated in all models. After allowing for observable heterogeneity, service users' preferences appeared to be more closely associated with their own SCRQoL than with those of the general population. The consistency of the results with the results of a previous study allowed the final model to be based on the preferences of 1000 members of the general population. A formula based on the relationship between TTO and BWS values was estimated for a social care QALY, with '0' equivalent to 'being dead' and '1' being the 'ideal' SCRQoL state. Members of the population experienced significantly higher SCRQoL than service users.Conclusions: Although further work is needed, particularly to develop an equivalent measure for informal carers and to explore the links with health QALYs, the measure has considerable potential. A number of methodological advances were achieved, including the first application of TTO in a social care context and use of BWS to establish service user preferences.