Exploring the Factors that Drive Clinical Negligence Claims: Stated Preferences of Those Who Have Experienced Unintended Harm.

Background: Better understanding of the factors that influence patients to make a financial claim for compensation is required to inform policy decisions. This study aimed to assess the relative importance of factors that influence those who have experienced a patient safety incident (PSI) to make a claim for compensation.

Method: Participants completed an online discrete choice experiment (DCE) involving 10 single profile tasks where they chose whether or not to file a claim.

The impact of adult children living at home on the well-being of Spanish parents: Evidence from panel data.

Despite the prevalence of co-residence of adult children and their parents across Europe, there is only limited empirical evidence on the impact of such living arrangements on well-being. This paper investigates the impact of adult children living in the household on the well-being of Spanish parents aged 50-75. Using three waves of panel data from the Spanish Survey of Household Finances we assess whether the impact on parental well-being differs depending on the age of the child, and whether the effect depends on the gender of the parent.

A Discrete Choice Experiment to Elicit General Population Preferences Around the Factors Influencing the Choice to Make Clinical Negligence Claims.

Objectives: This article determines public stated preferences around different factors that influence the choice to make clinical negligence claims against a national healthcare system.

Methods: A large online survey was conducted using a discrete choice experiment (DCE) with the UK general population (N = 1013). DCE tasks involved a single profile and participants chose whether to make a claim for compensation (yes/no) after one of 3 randomly allocated patient safety incident (PSI) "scenarios" of different severities (mild, moderate, severe).

Valuing quality in mental healthcare: A discrete choice experiment eliciting preferences from mental healthcare service users, mental healthcare professionals and the general population.

High and sustained healthcare quality is important worldwide, though health policy may prioritise the achievement of certain aspects of quality over others. This study determines the relative importance of different aspects of mental healthcare quality to different stakeholders by eliciting preferences in a UK sample using a discrete choice experiment (DCE). DCE attributes were generated using triangulation between policy documents and mental healthcare service user and mental healthcare professional views, whilst ensuring attributes were measurable using available data.

Patient Preferences for Longer or More Frequent In-Center Hemodialysis Regimens: A Multicenter Discrete Choice Study.

Rationale & Objective: Longer and more frequent hemodialysis sessions are associated with both benefits and harms. However, their relative importance to patients and how they influence acceptability for patients have not been quantified.

Study Design: Discrete-choice experiment in which a scenario followed by 12 treatment choice sets were presented to patients in conjunction with varying information about the clinical impact of the treatments offered.

Manipulating the 5 Dimensions of the EuroQol Instrument: The Effects on Self-Reporting Actual Health and Valuing Hypothetical Health States.

The EQ-5D instrument has 5 dimensions. This article reports on the effects of manipulating a) the order in which the 5 dimensions are presented (appearing first v. last), b) splitting of the composite dimensions ("pain or discomfort" and "anxiety or depression"), and c) removing or "bolting off" 1 of the 5 EQ-5D dimensions at a time.

An exploration of the non-iterative time trade-off method to value health states.

Time Trade-Off (TTO) usually relies on "iteration," which is susceptible to bias. Discrete Choice Experiment with duration (or DCE ) is free of such bias, but respondents find this cognitively more challenging. This paper explores non-iterative TTO with or without lead time: NI(LT)TTO.

Allocating external financing for health: a discrete choice experiment of stakeholder preferences.

Most donors of external financing for health use allocation policies to determine which countries are eligible to receive financial support and how much support each should receive. Currently, most of these policies place a great deal of weight on income per capita as a determinant of aid allocation but there is increasing interest in putting more weight on other country characteristics in the design of such policies. It is unclear, however, how much weight should be placed on other country characteristics.

Discrete Choice Experiments: A Guide to Model Specification, Estimation and Software.

We provide a user guide on the analysis of data (including best-worst and best-best data) generated from discrete-choice experiments (DCEs), comprising a theoretical review of the main choice models followed by practical advice on estimation and post-estimation. We also provide a review of standard software. In providing this guide, we endeavour to not only provide guidance on choice modelling but to do so in a way that provides a 'way in' for researchers to the practicalities of data analysis.

Using Discrete Choice Experiments with Duration to Model EQ-5D-5L Health State Preferences.

Background: Discrete choice experiments incorporating duration can be used to derive health state values for EQ-5D-5L. Yet, methodological issues relating to the duration attribute and the optimal way to select health states remain. The aims of this study were to: test increasing the number of duration levels and choice sets where duration varies (aim 1); compare designs with zero and non-zero prior values (aim 2); and investigate a novel, two-stage design to incorporate prior values (aim 3).

GPs' implicit prioritization through clinical choices - evidence from three national health services.

We present results from an extensive discrete choice experiment, which was conducted in three countries (Norway, Scotland, and England) with the aim of disclosing stated prescription behaviour in different decision making contexts and across different cost containment cultures. We show that GPs in all countries respond to information about societal costs, benefits and effectiveness, and that they make trade-offs between them. The UK GPs have higher willingness to accept costs when they can prescribe medicines that are cheaper or more preferred by the patient, while Norwegian GPs tend to have higher willingness to accept costs for attributes regarding effectiveness or the doctors' experience.

Eliciting Societal Preferences for Weighting QALYs for Burden of Illness and End of Life.

Objectives: . Recent proposals for value-based assessment, made by the National Institute of Health and Care Excellence (NICE) in the United Kingdom, recommended that burden of illness (BOI) should replace end of life (EOL) as a factor for consideration when deciding on new health technologies. This article reports on a study eliciting societal preferences for 1) BOI from a medical condition, defined as quality-adjusted life year (QALY) loss due to premature mortality and prospective morbidity, and 2) EOL, defined as expected life expectancy of less than 2 years and expected life expectancy gain from new treatment of 3 months or more.

Response Patterns in Health State Valuation Using Endogenous Attribute Attendance and Latent Class Analysis.

Not accounting for simplifying decision-making heuristics when modelling data from discrete choice experiments has been shown potentially to lead to biased inferences. This study considers two ways of exploring the presence of attribute non-attendance (that is, respondents considering only a subset of the attributes that define the choice options) in a health state valuation discrete choice experiment. The methods used include the latent class (LC) and endogenous attribute attendance (EAA) models, which both required adjustment to reflect the structure of the quality-adjusted life year (QALY) framework for valuing health outcomes.

Testing a discrete choice experiment including duration to value health states for large descriptive systems: addressing design and sampling issues.

There is interest in the use of discrete choice experiments that include a duration attribute (DCETTO) to generate health utility values, but questions remain on its feasibility in large health state descriptive systems. This study examines the stability of DCETTO to estimate health utility values from the five-level EQ-5D, an instrument with depicts 3125 different health states. Between January and March 2011, we administered 120 DCETTO tasks based on the five-level EQ-5D to a total of 1799 respondents in the UK (each completed 15 DCETTO tasks on-line).

Accounting for Attribute-Level Non-Attendance in a Health Choice Experiment: Does it Matter?

An extensive literature has established that it is common for respondents to ignore attributes of the alternatives within choice experiments. In most of the studies on attribute non-attendance, it is assumed that respondents consciously (or unconsciously) ignore one or more attributes of the alternatives, regardless of their levels. In this paper, we present a new line of enquiry and approach for modelling non-attendance in the context of investigating preferences for health service innovations.

Preparatory study for the revaluation of the EQ-5D tariff: methodology report.

Background: EQ-5D is a widely used generic measure of health with a 'tariff', or preference weights, obtained from the general population, using time trade-off (TTO). PRET (Preparatory study for the Re-valuation of the EQ-5D Tariff project) contributes towards the methodology for its revaluation.

Methods: Stage 1 examined key assumptions typically involved in health-state valuations through a series of binary choice exercises, namely that health-state preferences are independent of (1) duration of the state; (2) whose health it is (i.

When you can't have the cake and eat it too: a study of medical doctors' priorities in complex choice situations.

Available literature provides little insight into medical doctors' prescription choices when they are required to make complex trade-offs between different concerns such as treatment effect, costs, and patient preferences simultaneously. This study investigates this issue. It is based on a Discrete Choice Experiment (DCE) conducted with 571 Norwegian doctors, where the DCE captures preferences for medications described along five dimensions important for both clinical decision-making and prioritisation in the health sector.

Measuring and testing for gender discrimination in physician pay: English family doctors.

In 2008 the income of female GPs was 70%, and their wages (income per hour) were 89%, of those of male GPs. We estimate Oaxaca decompositions using OLS models of wages and 2SLS models of income and propose a set of new direct tests for within workplace gender discrimination. The direct tests are based on a comparison of the differences in income of female and male GPs in practices with varying proportions of female GPs and with female or male senior partners.

Determinants of general practitioners' wages in England.

We analyse the determinants of annual net income and wages (net income/hours) of general practitioners (GPs) using data for 2271 GPs in England recorded during Autumn 2008. The average GP had an annual net income of £97,500 and worked 43 h per week. The mean wage was £51 per h.

What patients want from primary care consultations: a discrete choice experiment to identify patients' priorities.

Purpose: The consultation is fundamental to the delivery of primary care, but different ways of organizing consultations may lead to different patient experiences in terms of access, continuity, technical quality of care, and communication. Patients' priorities for these different issues need to be understood, but the optimal methods for assessing priorities are unclear. This study used a discrete choice experiment to assess patients' priorities.

Modelling heterogeneity in patients' preferences for the attributes of a general practitioner appointment.

This paper examines the distribution of preferences among respondents to a discrete choice experiment on the choice of general practitioner appointments. In addition to standard logit, mixed and latent class logit models are used to analyse the data from the choice experiment. It is found that there is significant preference heterogeneity for all the attributes in the experiment and that both the mixed and latent class models lead to significant improvements in fit compared to the standard logit model.

The work hours of GPs: survey of English GPs.

Background: There is no current information about the hours worked by English GPs.

Aim: To compare the reported hours worked by GPs with that of other professions and to explain the variation in GP hours worked and on call.

Design Of Study: National postal survey of 1871 GPs in February 2004.

A comparison of approaches to estimating confidence intervals for willingness to pay measures.

This paper describes four approaches to estimating confidence intervals for willingness to pay measures: the delta, Fieller, Krinsky Robb and bootstrap methods. The accuracy of the various methods is compared using a number of simulated datasets. In the majority of the scenarios considered all four methods are found to be reasonably accurate as well as yielding similar results.