TITLE:
Examining older patient preferences for quality of care in postacute transition care and day rehabilitation programs
AUTHORS:
Leah Couzner, Maria Crotty, Ruth Walker, Julie Ratcliffe
KEYWORDS:
DCE; Patient Preferences; Aged; Rehabilitation; Intermediate Care Facilities
JOURNAL NAME:
Health,
Vol.5 No.6B,
June
27,
2013
ABSTRACT: Background: Quality
in health care has traditionally been determined based on clinical or health
outcomes. However, these factors may not be the only aspects of health care
that are important to patients. Within rehabilitation factors related to the
process of care, the way in which rehabilitation services are delivered, may
also be important to patients when defining quality of care. Objective: The
purpose of this study was to examine and compare the preferences of older
people receiving post-acute outpatient rehabilitation or residential
intermediate (transition) care for alternative configurations of rehabilitation
programs. Methods: A discrete choice experiment (DCE) was designed to elicit
the preferences of older people for the design and delivery of post-acute
rehabilitation programs. The participants were older adults (≥65 years)
receiving post-acute outpatient rehabilitation or residential intermediate
(transition) care in South Australia. Each participant was presented with a
series of choice questions involving two hypothetical programs, the characteristics
of which varied in every choice. Participants were then asked to select their
preferred program. Results: Despite marked differences in case-mix and
dependency levels, the preferences of the two groups were very similar,
focusing on relationships and communication with health care professionals.
Both groups demonstrated very strong preferences for the use of an electronic
medical record and for receiving information about their treatment and
progress via a meeting with a specialist physician and nurse. The outpatient
rehabilitation group also exhibited a strong preference for a shared decision
making model in relation to their future care needs. Conclusions: The findings
highlight the commonality of preferences of older patients receiving post-acute
services for the optimal configuration of rehabilitation services. Issues
prioritised were service integration and access to senior medical and nursing
staff. The study demonstrates the practicality and validity of DCEs to
determine older people’s preferences in defining quality of care.