Establishing a composite endpoint for measuring the effectiveness of geriatric interventions based on older persons’ and informal caregivers’ preference weights: a vignette study

BMC Geriatrics

René JF Melis³  Rogier ART Donders¹  Marcel GM Olde Rikkert³  Anton JM de Craen⁴  Bianca M Buurman⁵  Han Boter²  Peter Makai³  Cynthia S Hofman¹ 

[1] Department for Health Evidence (HP133), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, Netherlands;Department of Epidemiology (FA41), University of Groningen, University Medical Centre, Groningen, PO Box 30001, 9700 RB, Groningen, Netherlands;Department of Geriatric Medicine (HP 925), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, Netherlands;Department of Gerontology and Geriatrics (C2-R), Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, Netherlands;Department of Internal Medicine, Section of Geriatric Medicine (F4-108), Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, Netherlands

关键词: Geriatric interventions;    Effectiveness;    Informal caregivers;    Elderly persons;    Preference-weighted;    Composite endpoint;   

Others  :  855133
DOI  :  10.1186/1471-2318-14-51

 received in 2013-08-26, accepted in 2014-04-07,  发布年份 2014

【 摘 要 】

Background

The Older Persons and Informal Caregivers Survey Minimal Dataset’s (TOPICS-MDS) questionnaire which measures relevant outcomes for elderly people was successfully incorporated into over 60 research projects of the Dutch National Care for the Elderly Programme. A composite endpoint (CEP) for this instrument would be helpful to compare effectiveness of the various intervention projects. Therefore, our aim is to establish a CEP for the TOPICS-MDS questionnaire, based on the preferences of elderly persons and informal caregivers.

Methods

A vignette study was conducted with 200 persons (124 elderly and 76 informal caregivers) as raters. The vignettes described eight TOPICS-MDS outcomes of older persons (morbidity, functional limitations, emotional well-being, pain experience, cognitive functioning, social functioning, self-perceived health and self-perceived quality of life) and the raters assessed the general well-being (GWB) of these vignette cases on a numeric rating scale (0–10). Mixed linear regression analyses were used to derive the preference weights of the TOPICS-MDS outcomes (dependent variable: GWB scores; fixed factors: the eight outcomes; unstandardized coefficients: preference weights).

Results

The mixed regression model that combined the eight outcomes showed that the weights varied from 0.01 for social functioning to 0.16 for self-perceived health. A model that included “informal caregiver” showed that the interactions between this variable and each of the eight outcomes were not significant (p > 0.05).

Conclusion

A preference-weighted CEP for TOPICS-MDS questionnaire was established based on the preferences of older persons and informal caregivers. With this CEP optimal comparing the effectiveness of interventions in older persons can be realized.

【 授权许可】

   
2014 Hofman et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Humphreys G: The health-care challenges posed by population ageing. Bull World Health Organ 2012, 90(2):82-83.
• [2]How can health systems respond to population ageing? 2009. [http://www.euro.who.int/__data/assets/pdf_file/0004/64966/E92560.pdf webcite]
• [3]Basu A, Philipson TJ: The impact of comparative effectiveness research on health and health care spending. Cambridge: Mass. National Bureau of Economic Research; 2010.
• [4]Porter ME: What is value in health care? N Engl J Med 2010, 363(26):2477-2481.
• [5]Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G: Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004, 59(3):255-263.
• [6]Lutomski JE, Baars MA, Schalk BW, Boter H, Buurman BM, den Elzen WP, Jansen AP, Kempen GI, Steunenberg B, Steyerberg EW, Olde Rikkert MG, Melis RJ, Topics-Mds Consortium: The Development of the Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS): A Large-Scale Data Sharing Initiative. PLoS One 2013, 8(12):e81673.
• [7]TOPICS-MDS - Supporting documentation [http://topics-mds.nl/wordpress/?page_id=34 webcite]
• [8]Neuhauser M: How to deal with multiple endpoints in clinical trials. Fund Clinical Pharma 2006, 20(6):515-523.
• [9]Veit CT, Ware JE: Measuring health state and health care outcomes: Issues and recommendations. In Values and Long Term Care. Edited by Kane RL, Kane RA. Lexington MA: Lexington Books; 1982:233-259.
• [10]Sackett DL, Torrance GW: The utility of different health states as perceived by the general public. J Chron Dis 1978, 31(11):697-704.
• [11]Gerteis M, Picker/Commonwealth Program for Patient-Centered Care: Through the patient's eyes: understanding and promoting patient-centered care. 1st edition. San Francisco: Jossey-Bass; 1993.
• [12]Say RE, Thomson R: The importance of patient preferences in treatment decisions–challenges for doctors. BMJ 2003, 327(7414):542-545.
• [13]Van Houtven CH, Norton EC: Informal care and health care use of older adults. J Health Econ 2004, 23(6):1159-1180.
• [14]Brazier J, Roberts J, Deverill M: The estimation of a preference-based measure of health from the SF-36. J Health Econ 2002, 21(2):271-292.
• [15]Atzmuller C, Steiner PM: Experimental Vignette Studies in Survey Research. Methodol-Eur 2010, 6(3):128-138.
• [16]Alexander CS, Becker HJ: The use of vignettes in survey research. Public Opin Q 1978, 42(1):93-104.
• [17]Ludwick R, Zeller RA: The factorial survey: an experimental method to replicate real world problems. Nurs Res 2001, 50(2):129-133.
• [18]Farshad M, Gerber C, Szucs T, Meyer DC: Determining utility values in patients with anterior cruciate ligament tears using clinical scoring systems. BMC Health Serv Res 2011, 11:182. BioMed Central Full Text
• [19]Muller-Engelmann M, Krones T, Keller H, Donner-Banzhoff N: Decision making preferences in the medical encounter–a factorial survey design. BMC Health Serv Res 2008, 8:260. BioMed Central Full Text
• [20]Definitie mantelzorg (In Dutch only) [http://www.nationaalprogrammaouderenzorg.nl/fileadmin/www.npoz.nl/documenten/toolkits/mantelzorgdefinitie_def.pdf webcite]
• [21]Lokale en nationale monitor gezondheid (In Dutch only) [https://www.monitorgezondheid.nl/gezondheidindicatoren.aspx webcite]
• [22]Weinberger M, Samsa GP, Schmader K, Greenberg SM, Carr DB, Wildman DS: Comparing proxy and patients’ perceptions of patients’ functional status: results from an outpatient geriatric clinic. J Am Geriatr Soc 1992, 40(6):585-588.
• [23]VanderZee KI, Sanderman R, Heyink JW, de Haes H: Psychometric qualities of the RAND 36-Item Health Survey 1.0: a multidimensional measure of general health status. Int J Behav Med 1996, 3(2):104-122.
• [24]Krabbe PF, Stouthard ME, Essink-Bot ML, Bonsel GJ: The effect of adding a cognitive dimension to the Euro Qol multiattribute health-status classification system. J Clin Epidemiol 1999, 52(4):293-301.
• [25]Gomez-Gallego M, Gomez-Amor J, Gomez-Garcia J: Determinants of quality of life in Alzheimer's disease: perspective of patients, informal caregivers, and professional caregivers. Int Psychogeriatr 2012, 24(11):1805-1815.
• [26]Huang HL, Chang MY, Tang JS, Chiu YC, Weng LC: Determinants of the discrepancy in patient- and caregiver-rated quality of life for persons with dementia. J Clin Nurs 2009, 18(22):3107-3118.
• [27]Crespo M, Bernaldo de Quiros M, Gomez MM, Hornillos C: Quality of life of nursing home residents with dementia: a comparison of perspectives of residents, family, and staff. Gerontol 2012, 52(1):56-65.
• [28]Moyle W, Murfield JE, Griffiths SG, Venturato L: Assessing quality of life of older people with dementia: a comparison of quantitative self-report and proxy accounts. J Adv Nurs 2012, 68(10):2237-2246.
• [29]Schwartz CE, Sprangers MA: Methodological approaches for assessing response shift in longitudinal health-related quality-of-life research. Soc Sci Med 1999, 48(11):1531-1548.
• [30]Rapkin BD, Schwartz CE: Toward a theoretical model of quality-of-life appraisal: Implications of findings from studies of response shift. Health Qual Life Outcomes 2004, 2:14. BioMed Central Full Text
• [31]Neumann PJ, Araki SS, Gutterman EM: The use of proxy respondents in studies of older adults: lessons, challenges, and opportunities. J Am Geriatr Soc 2000, 48(12):1646-1654.
• [32]Bevolking; geslacht, leeftijd en burgerlijke staat (In Dutch only) [http://statline.cbs.nl/StatWeb/selection/?DM=SLNL&PA=7461BEV&VW=T webcite]
• [33]Dolan P: Effect of age on health state valuations. J Health Serv Res Policy 2000, 5(1):17-21.
• [34]Wittenberg E, Halpern E, Divi N, Prosser LA, Araki SS, Weeks JC: The effect of age, race and gender on preference scores for hypothetical health states. Qual Life Res 2006, 15(4):645-653.
• [35]van der Heijde DM, van't Hof MA, van Riel PL, van Leeuwen MA, van Rijswijk MH, van de Putte LB: Validity of single variables and composite indices for measuring disease activity in rheumatoid arthritis. Ann Rheum Dis 1992, 51(2):177-181.
• [36]Fuchs HA: The Use of the Disease-Activity Score in the Analysis of Clinical-Trials in Rheumatoid-Arthritis. Br J Rheumatol 1993, 20(11):1863-1866.