Application of Conjoint Analysis to Preferences of Low *

描述：拟议的研究使用联合分析(CA)来得出 HMO下腰痛患者对脊椎按摩和治疗的偏好 初级保健就诊因过程和健康结果的不同而有所不同。 通过管理数据确定的研究对象将收到一封邮件 问卷，其核心是一套10-12个假设选择 在因结果和过程的特定属性而不同的访问之间， 包括成本在内。回复将使用概率回归进行分析，该回归基于 随机效用理论。可靠的、可推广的经济评价 补充和替代医学(CAM)中的疗法，如脊椎疗法 需要用于通知健康保险公司的资源分配决策，以及 付款人。因为CAM的大部分好处是生活质量的改善，而不是 与延长寿命相比，适当的效用估计将是至关重要的。我们 假设对“过程”的评估？公用事业将特别 在CAM环境中很重要，基于大量研究表明 CAM的治疗益处(例如，保证、信息)不只是直接的 健康结果。CA在经济评估中可能具有相当大的价值 因为理论上它既能产生效用，又能产生支付意愿 (WTP)估计包括了过程和最终结果。这个 本研究的具体目的是：(1)进行联合的可行性研究 分析作为一种引起对脊椎疗法偏好的方法 人群中急性下腰痛的常规治疗 凯撒永久西北医院大约400名成年成员被诊断出患有 急性下腰痛，侧重于有效性和可靠性的评估， 包括应答者负担和内部一致性；(2)初步制作 同时包含过程和结果属性的效用估计，用于 在下腰痛治疗的成本-效用分析中的最终使用 HMO上下文；以及(3)产生过程属性的初步WTP估计 最终用于成本效益分析的下腰痛治疗 HMO上下文。这项研究将产生有用的初步数据，为 未来发展的效益评估方法，适用于 脊椎疗法和对这两种方法都敏感的经济学评价 和结果。我们预计，从这项研究中得出的经验教训将很容易推广到 对其他治疗方法在CAM中以及在 传统医学，特别是在管理保健背景下提供的那些。

DESCRIPTION: The proposed study uses conjoint analysis (CA) to elicit preferences of a sample of HMO low back pain patients for chiropractic and primary care visits that vary by attributes of process and health outcomes. Study subjects identified through administrative data will receive a mail questionnaire, the core of which is a set of 10- 12 hypothetical choices between visits that vary by specified attributes of outcome and process, including cost. Responses will be analyzed using probit regression based on random utility theory. Reliable and generalizable economic evaluations of therapies in complementary and alternative medicine (CAM) such as chiropractic are needed to inform resource allocation decisions of health insurers and payers. Since most benefits from CAM are quality of life improvements rather than life extension, appropriate utility estimates will be crucial. We hypothesize that assessments of "process"? utility will be especially important in the CAM context, based on considerable research suggesting that therapeutic benefits from CAM (e.g., reassurance, information) beyond direct health outcomes. CA may be potentially quite valuable in economic evaluations of CAM because in theory it can produce both utility and willingness to pay (WTP) estimates that incorporate process as well as final outcome. The specific aims of this study are to (1) conduct a feasibility study of conjoint analysis as a method of eliciting preferences over chiropractic and conventional treatment of acute low back pain among a population of approximately 400 adult members of Kaiser Permanente Northwest diagnosed with acute low back pain, focusing on assessments of validity and reliability, including respondent burden and internal consistency; (2) produce preliminary utility estimates that incorporate both process and outcome attributes, for eventual use in cost-utility analyses of low back pain treatment within the HMO context; and (3) produce preliminary WTP estimates for process attributes of low back pain treatment for eventual use in cost-benefit analyses within the HMO context. This study will generate useful preliminary data that informs the future development of benefit assessment methods that are appropriate for economic evaluations of chiropractic and that are sensitive to both process and outcome. We expect that lessons from this study will readily generalize to future economic evaluations of other therapies in CAM as well as in conventional medicine, especially those delivered in the managed care context.