Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, MD.
AETNA, Managed Care Pharmacy, Phoenix AZ.
J Dev Behav Pediatr. 2018 Feb/Mar;39(2):101-108. doi: 10.1097/DBP.0000000000000525.
Health care decision-making for youth with mental health multimorbidity is guided by outcomes that are considered most meaningful and important. The study objective was to pilot test a best-worst scaling (BWS) instrument designed to assess trade-offs among caregiver-defined, meaningful health care outcomes.
A BWS was designed with continuous stakeholder involvement to elicit caregiver-defined outcomes in 4 domains: school, behavioral, social, and independence. Four attributes were identified for each outcome domain, for a total of 16 attributes. Using a balanced incomplete block design, a BWS instrument was developed with 16 choice task questions displaying 6 attributes at a time. A convenience sample was selected from Maryland caregivers of children who were 21 years old or younger and had a developmental delay and a comorbid mental health condition. Participants completed a survey that included demographics and the BWS instrument. Conditional logit was used to estimate utility scores and 95% confidence intervals (CI) for each attribute, which were ranked in order of importance. Attribute statements were refined after a respondent debriefing session.
A total of 38 caregivers participated in the pilot study. Child safety to self was the most important outcome (1.01, CI, 0.78-1.24). This was followed by securing support for an Individualized educational plan in school (0.77, CI, 0.54-1.01) and the child being able to stay in school all day (0.53, CI, 0.29-0.77).
BWS scenarios that resemble real-life decision-making can be a useful tool to identify preferences for health care outcomes.
青少年心理健康多病种的医疗决策由被认为最有意义和最重要的结果指导。本研究的目的是对 caregiver 定义的有意义的医疗结果进行权衡的最佳最差分级（BWS）工具进行试点测试。
采用连续利益相关者参与的方式设计了 BWS，以在 4 个领域中获取 caregiver 定义的结果：学校、行为、社会和独立性。为每个结果领域确定了 4 个属性，总共 16 个属性。使用平衡不完全区块设计，开发了一个 BWS 工具，其中包含 16 个选择任务问题，一次显示 6 个属性。从马里兰州的发育迟缓且合并有心理健康状况的 21 岁或以下儿童的 caregiver 中选择了一个方便样本。参与者完成了一份包含人口统计数据和 BWS 工具的调查。条件逻辑回归用于估计每个属性的效用得分和 95%置信区间（CI），并按照重要性进行排名。在受访者的情况汇报会议后，对属性陈述进行了修订。
共有 38 名 caregiver 参加了试点研究。儿童的自我安全是最重要的结果（1.01，CI，0.78-1.24）。其次是确保孩子在学校获得个人教育计划的支持（0.77，CI，0.54-1.01）和孩子能够全天留在学校（0.53，CI，0.29-0.77）。
类似于实际决策的 BWS 情景可以成为识别医疗结果偏好的有用工具。
