Exploring Comparative Effectiveness & Efficiency in Long-term Care

To meet societal and economic challenges, health and care welfare regimes will need to become much more focused on the outcomes that matter to people and deliver these programmes effectively and efficiently. Central to this goal is the need to accurately measure outcomes and reflect the value of those outcomes. We propose a cross-country study to measure outcomes in the field of long-term care (LTC). We will use a care-related outcome tool, ASCOT, to assess the comparative effectiveness and efficiency of non-institutional LTC (e.g. home care) for older adults and their informal carers in Austria, England and Finland. The study has four analytical workpackages with these goals: Establish a valid basis for international comparisons of LTC-outcomes in noninstitutional settings, by developing rigorously translated and tested versions of ASCOT. Generate country-specific ASCOT utility weights and explore variations in preferences for ASCOT quality of life domains across countries. Explore variations in ASCOT-quality of life (QoL) within and between countries, providing evidence on QoL for service users, carers and the relationship between them, as well as QoL inequalities. Explore and compare the relative costs, efficiency and cost-effectiveness of specific LTC services. We will use econometric methods, combining estimates of the effect of services on QoL and service cost. This study should strengthen the research base and help guide policymakers and practitioners to make outcomes-focused, economically-sound decisions about LTC. It will also provide useful tools for future evaluations.

Long-term care highly needed in aging societies but poor evidence base Long-term care (LTC) provides essential support for older adults who are no longer able to cope with activities of daily living. The evidence base of this policy field is, however, underdeveloped in many countries. Particularly little is known about the impact of LTC services on the quality of life of care-dependent people and their informal carers. Aims of the EXCELC project The collaborative project EXCELC involved three countries Austria, England and Finland and aimed to collect evidence on quality of life outcomes of home care service provision. To this purpose we aimed to (i) develop outcome tools for care-dependent people and informal carers in Austria and Finland based on an existing English instrument (ASCOT Adult Social Care Outcome toolkit), (ii) collect data from the general population to describe the preferences of LTC outcome states in each country and (iii) compare the impact of LTC services on peoples quality of life across the three countries, namely Austria, England and Finland. Highlights of the EXCELC project We developed cross-culturally valid ASCOT instruments for LTC service users and informal carers for Austria and Finland. These instruments can be used free of charge for non-commercial purposes by contacting ascot@kent.ac.uk. People in Austria, England, and Finland were relatively consistent in their ratings of areas of life that are important to them in case of care dependency or in case of informally supporting a care dependent person. For example, people valued having control over daily life or being occupied in a meaningful way more highly than being clean and feeling safe. Comparing the impact of LTC services across Austria, England, and Finland, we found a slightly lower impact for Austria than for the other two countries, after controlling for personal characteristics. We found factors that affect LTC service users in all countries, e.g. the level of needs and care intensity, in addition to country-specific effects for e.g. the availability of informal care and social contact. Contribution of the EXCELC project We have provided means for systematically measuring and comparing the impact of LTC services on peoples quality of life. Fully-tested tools that can be used by policymakers, care managers and researchers were highly needed as the data base still needs to be improved. For the first time we compared the impact of care on quality of life across three countries which may encourage other countries to learn more about the effect of long-term care. In addition, we contributed by eliciting preferences for LTC-service related outcome states.