Med Decis Making - Quantifying long-term care preferences.

Tópicos

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Resumo

CKGROUND: . Current policies redirecting long-term care (LTC) delivery away from institutional care to home- and community-based services are being made in the absence of crucial evidence on preferences. Studies indicate that the shift to home care is generally not cost-saving; thus, an empirical assessment of effectiveness is needed to evaluate policies incenting home care investment. This study quantifies LTC preferences between different delivery modes.DESIGN: . This study extended the time tradeoff method to elicit utilities and LTC preferences associated with the receipt of different modes of LTC services, conditional on health states defined by varying levels of functional and cognitive impairment. Users' LTC preferences are measured as differential utilities between alternative LTC options for each health state.RESULTS: . For the same health state, respondents (n = 81) significantly preferred home care over institutional care, except for the most impaired health state. The preference for home care over institutional care is quantified as 0.30 quality-of-life (QOL) weight when people need help with only 1 activity of daily living (ADL). The preference for home care depends significantly on levels of disability and was weaker once the need for help became greater. Under the most severe health state of having moderate to severe dementia and needing help with 6 ADLs, the quantified home care preference was only 0.03 QOL weight and was not statistically significant.LIMITATIONS: . Because the sample is mostly composed of African Americans, the results may not be generalizable to other racial and ethnic groups.CONCLUSIONS: . People do not always strongly prefer home care over institutional care, as is often assumed. The costs of expanding home- and community-based care should be weighed against these preferences.

Resumo Limpo

ckground current polici redirect longterm care ltc deliveri away institut care home communitybas servic made absenc crucial evid prefer studi indic shift home care general costsav thus empir assess effect need evalu polici incent home care invest studi quantifi ltc prefer differ deliveri modesdesign studi extend time tradeoff method elicit util ltc prefer associ receipt differ mode ltc servic condit health state defin vari level function cognit impair user ltc prefer measur differenti util altern ltc option health stateresult health state respond n signific prefer home care institut care except impair health state prefer home care institut care quantifi qualityoflif qol weight peopl need help activ daili live adl prefer home care depend signific level disabl weaker need help becam greater sever health state moder sever dementia need help adl quantifi home care prefer qol weight statist significantlimit sampl most compos african american result may generaliz racial ethnic groupsconclus peopl alway strong prefer home care institut care often assum cost expand home communitybas care weigh prefer

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