Measuring and valuing quality of care for older adults in subacute settings: A health economics perspective

Author: Leah Couzner

Couzner, Leah, 2017 Measuring and valuing quality of care for older adults in subacute settings: A health economics perspective, Flinders University, School of Medicine

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Ageing populations are predicted to increase demand for health and aged care services markedly during the coming decades. In addition older adults increasingly have rising expectations regarding the quality of the care they receive. This thesis aimed to investigate, from a health economics perspective, mechanisms for examining the quality of care of older adults in subacute care settings. Quality of care was examined through an investigation of process (the way in which subacute care services are delivered) and outcome (the measurement and valuation of the quality of life of older adults receiving subacute care). The thesis also aimed to compare the quality of life experienced by a subacute sample to that of a general population sample.

Eighty-six adults aged 65 years and over and receiving subacute outpatient day rehabilitation or residential Transition Care in Adelaide, South Australia participated in face-to-face interviews in which they completed validated instruments to measure their capability-based quality of life (ICECAP-O), health-related quality of life (EQ-5D-3L) and quality of care transitions (CTM-3). The respondents also completed a discrete choice experiment in which they were presented with alternative configurations of rehabilitation programs and asked to choose which programs they would prefer to receive. To generate population norms for the ICECAP-O and the EQ-5D-3L and to facilitate comparisons of the quality of life of the subacute care sample with the general population, a total of 1,174 Australians aged 65 years and over participated in face-to-face interviews or online questionnaires to complete the ICECAP-O or EQ-5D-3L.

The thesis identified a limited use of preference-based instruments to date in measuring quality of life in subacute care. The subacute care recipients reported upon in this thesis exhibited higher levels of capability-based quality of life in general than health-related quality of life. As expected, when compared with that of the general population the subacute care recipient group were found to have lower levels of quality of life. However in general, the differences in EQ-5D-3L values between the subacute care recipients and the general population was more pronounced than those for the ICECAP-O. The subacute care recipients reported experiencing high quality transitions between health care settings, with the quality of care transitions being more strongly correlated with capability-based quality of life than health-related quality of life. Analysis of the subacute care recipients’ preferences for the process of care using discrete choice experiment methodology indicated that similar aspects of care were important to both the outpatient day rehabilitation and residential Transition Care recipients. Strong preferences were evident for a shared decision-making approach and for the use of electronic medical records to transfer information between health and aged care settings.

In summary, the empirical findings from this thesis highlight the strong relationships between process and outcome for older adults receiving subacute care. Health, quality of life and the quality of care transitions were found to be inter-related. Older adults also demonstrated the ability to participate in the assessment of quality of care through application of discrete choice experiment methodology with the clear identification of preferences for aspects of subacute care that they value.

Keywords: quality of care, quality of life, aging, health services for the aged, health economics

Subject: Medicine thesis

Thesis type: Doctor of Philosophy
Completed: 2017
School: School of Medicine
Supervisor: Profesor Julie Ratcliffe