Examining older patient preferences for quality of care in postacute transition care and day rehabilitation programs
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Background: Quality in health care has tradi- tionally 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 fac- tors 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 prefer- ences of older people receiving post-acute out- patient 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 pro- grams. The participants were older adults (≥65 years) receiving post-acute outpatient rehabili- tation or residential intermediate (transition) care in South Australia. Each participant was presented with a series of choice questions in- volving two hypothetical programs, the charac- teristics of which varied in every choice. Par- ticipants were then asked to select their pre- ferred program. Results: Despite marked differ- ences 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 re- ceiving information about their treatment and progress via a meeting with a specialist physi- cian 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 find- ings highlight the commonality of preferences of older patients receiving post-acute services for the optimal configuration of rehabilitation ser- vices. Issues prioritised were service integration and access to senior medical and nursing staff. The study demonstrates the practicality and va- lidity of DCEs to determine older people’s pref- erences in defining quality of care. Keywords: DCE; Patient Preferences; Aged; Rehabilitation; Intermediate Care Facilities
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