The current NHS plan is committed to giving patients and the public greater influence over the way the NHS modernizes. For example, moves to extend traditional roles for nurses and allied health professionals in the hospital, GP practice and wider community setting often provide opportunities to redesign the delivery of healthcare with a patient focus.
Most evaluation of new policy or service re-configuration requires the measurement and valuation of the benefits of the alternatives under consideration from the perspective of particular groups identified as being affected. There are many ways to take healthcare benefits into account; health outcomes, quality of life and quality of care are multi-dimensional concepts. As such different issues require different approaches and different individuals, in assessing these concepts will make different value trade-offs among the dimensions.
In a patient focussed health service we need to know not only overall value, but also the trade-offs among different attributes of services. The economic meaning of trade-offs is powerful and versatile: it represents people’s willingness to give up some amount of one attribute in order to achieve more of another. It may, for example, be used to inform the level of compensation (e.g. longer waiting time) required to change other aspects of a service (e.g. continuity of care) in order to provide optimal patient care which falls within a nurse’s responsibility. The Discrete Choice Experiment (DCE) is the best tool for enabling us to do this.
Three complementary areas of research and training are dealt with in this Fellowship. The first is to develop DCE methodology further; to that end three key issues have been identified from the literature (generalizability, qualitative/ mixed methods and econometric analysis). The second is to apply DCE for the first time to an important, yet challenging, aspect of patient choice, end of life care, and thereby strengthen policy-relevant multidisciplinary benefit assessment in this area. The third component is to build research capacity in DCE methods and application through the encouragement of researchers and professionals in the wider research and NHS communities to become semi-independent in this skill.
Dr Karen Gerard, Dr Timothy Bolt
National Institute of Health Research Career Development Award