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Related Experiment Video

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Measuring Delay Discounting in Humans Using an Adjusting Amount Task
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Quantifying long-term care preferences.

Jing Guo1, R Tamara Konetzka2, Elizabeth Magett3

  • 1American Institutes for Research, Washington, DC, USA (JG)

Medical Decision Making : an International Journal of the Society for Medical Decision Making
|October 10, 2014
PubMed
Summary
This summary is machine-generated.

People often prefer home care, but this preference lessens with increased disability. The study quantifies long-term care (LTC) preferences, finding home care is not always strongly preferred over institutional care, especially in severe health states.

Keywords:
cost-effectiveness analysislong-term carepreferencequality of lifetime tradeoff

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Area of Science:

  • Gerontology
  • Health Services Research
  • Health Economics

Background:

  • Current long-term care (LTC) policies favor home- and community-based services (HCBS) without strong evidence of user preferences.
  • Studies suggest HCBS shifts are not cost-saving, necessitating effectiveness evaluations for policy incentives.
  • This research quantifies preferences for different LTC delivery modes.

Purpose of the Study:

  • To elicit and quantify user preferences for different long-term care (LTC) delivery modes.
  • To assess how health states, including functional and cognitive impairment, influence LTC preferences.
  • To provide empirical data for evaluating policies promoting HCBS.

Main Methods:

  • Extended the time tradeoff method to derive quality-of-life (QOL) utilities.
  • Measured LTC preferences as differential utilities between home care and institutional care options.
  • Conditional analysis based on defined health states of functional and cognitive impairment.

Main Results:

  • Respondents significantly preferred home care over institutional care for less severe health states.
  • A preference for home care was quantified as a 0.30 QOL weight for needing help with one activity of daily living (ADL).
  • Preference for home care diminished with increased disability, becoming statistically insignificant in the most severe health state (dementia, 6 ADLs).

Conclusions:

  • The assumption of a strong, universal preference for home care over institutional care is not always valid.
  • The quantified preferences indicate that the strength of home care preference is contingent on the level of functional and cognitive impairment.
  • Policy decisions regarding the expansion of home- and community-based care must consider the nuanced preferences and associated costs.