Preference of nursing staff on providing " Internet + nursing service" for elderly patients / 中华医院管理杂志

Objective:To find the preferences of nursing staff when they provide " Internet + nursing service" for elderly patients.Methods:By means of the discrete choice experiment, a questionnaire was designed to investigate the preferences of nursing staff when they provide " Internet + nursing services" for elderly patients. In-service nursing staff from 8 medical and health institutions in Ningbo city and Wenzhou city were selected by random sampling, for an online questionnaire survey conducted from May to June 2022. The preferences of nursing staff on their service income, service content, service distance, service continuity and residence status of elderly patients when providing " Internet + nursing service" were analyzed by mixed logit regression.Results:A total of 420 valid questionnaires were collected. Compared to 50 yuan/order, nursing staff preferred to a price of 150 yuan/order ( β= 1.22, P<0.001) nursing services; Compared to specialized nursing services, nursing staff preferred to the routine care ( β= 0.86, P<0.001) and health promotion ( β= 0.86, P<0.05) service; Compared to<5 km, nursing staff were unwilling to provide nursing services for elderly patients at distances of 5-10 km and 11-15 km ( β=-0.66, P<0.05; β=-0.95, P<0.001) ; Compared to 1-2 visits per month, nursing staff preferred not to provide continuing care services ( β=-0.70, P<0.05); Compared to homestay with the patient family, nursing staff preferred to provide nursing services for elderly patients residing in nursing homes ( β= 1.21, P<0.001) . Conclusions:Considering the preference of nursing staff tend to provide " Internet + nursing service" for the elderly patients with services featuring appropriate price, non-specialist care, close distance, low continuity (moderate intensity used as the reference) and security assurance for practice.

Research on the willingness of county-level hospital physicians to participate in county-township human resource integration for medical institutions / 中华医院管理杂志

Objective:To study the willingness of county-level hospital physicians within a county medical alliance(alliance)to participate in county-township human resource integration for medical institutions, for furthering the development of such integration.Methods:Based on a discrete selection experiment, a questionnaire was designed for the selection of the work attributes that affect the participation of county-level hospital physicians in such an integration. On-the-job physicians from four county-level hospitals in a prefecture level city were selected by multi-stage stratified random sampling method as the survey objects, and a field questionnaire survey was conducted from November to December 2021. The mixed logit model was used to analyze the preference of physicians in county-level hospitals for five types of work attributes(work unit, monthly income, seniority required for professional title promotion, training opportunities, serving as middle-level and above administrators), the relative importance of each work attribute, and marginal willingness to pay with regard to their participation in the integration.Results:A total of 172 valid questionnaires were collected. When county-level hospital physicians participate in county-township human resource integration for medical institutions, their statistically significant job attributes and level preferences included monthly income, working unit of county-level hospitals, 7 years for professional title promotion, and more training opportunities ( P<0.001). The relative importance of monthly income ranked the highest among the five categories of work attributes, up to 55.55%. Conclusions:When physicians in county-level hospitals participate in the integration of county-township human resources, the most important was their monthly income, and economic incentives could enhance their willingness to participate.

Preference of Japanese Global Health Personnel—Lessons Learned from a Qualitative Study / 国際保健医療

Objectives  The need to develop and produce human resources for global health is increasing. The objective of this study was to reveal through qualitative research as a first step of Discrete Choice Experiment, which job ‘attributes’ are considered important by Japanese medical and non-medical personnel in considering employment at health-related international organizations. We then sought to identify appropriate support measures that match the chosen attributes for those who wish to work for international organizations. Methods  We requested a total of 20 subjects from 3 groups of Japanese medical and non-medical personnel; 1. those who wish to work for health-related international organizations (applicant group), 2. those who are currently working (working group) and, 3. those who resigned (resigned group).   Subjects were asked to choose and rank in order of importance, 11 pre-defined attributes when considering employment at international organizations, followed by semi-structured interviews.Results  All three groups chose job content, opportunity for self-realization and opportunity for capacity development as top three attributes. This was followed by duty station as second place tie for working group and fourth place for applicant and resigned groups.   However, for applicant and working groups, emphasis on employee’s entitlements such as work-life-balance, salary, welfare, job security/long-term contract ranked mid- to lower-level between fifth to eighth places. Guaranteed job where one can return to when one leaves the current post, ranked ninth place and opportunity for children’s education and opportunity for spouse’s job ranked tenth equally.   For the resigned group, work-life-balance and job security/long-term contract ranked fifth place equally but other attributes were not chosen.Conclusion  The study findings suggested that Japanese medical and non-medical personnel who aim for employment at health-related international organizations have tendencies to opt for utilization of their experiences and expertise, and search for capacity development and self-realization, rather than better employee entitlements or working/living conditions.   According to the attributes ranking, we consider implementation of career development seminars on expected job satisfaction at international organizations as the primary support measure to encourage and dispatch more personnel. However, publicity highlighting employee entitlements such as work-life-balance, working environment for women and welfare alongside salary may also provide better incentive.   Insecure contract terms, a lack of national organizations and hospitals that value the experience gained in international organizations present a challenge. There is a need to work with these organizations in the mid- to long-term to inform them on the benefits of accepting those staff wishing to return after a period working within international organizations.

Literature Analysis of the Application of Discrete Choice Experiment in the Treatment Preferences of Patient with Type 2 Diabetes / 中国药房

OBJECTIVE：To provide reference for the clinical treatment and pharmacoeconomics research of type 2 diabetes patients. METHODS ：Using“Discrete choice ”“Discrete ranking ”as Chinese keywords ，“Discrete choice ”“Discrete ranking ” “Conjoint analysis ”“Diabetes mellitus ”“Type 2”“Type 2 diabetes mellitus ”“Non-insulin-dependent diabetes mellitus ”as English keywords，Chinese and English literatures were retrieved from domestic and foreign databases as CNKI ，Wanfang database ， PubMed，Web of Science during the inception to Dec. 2019. The application status of discrete choice experiment （DCE）was analyzed and summarized from the aspect of attributes and levels ，DCE choice sets ，DCE data quality ，sample size ，econometrics analysis and the preference results. RESULTS & CONCLUSIONS ：A total of 295 related literatures were retrieved ，involving 30 valid literatures. The attributes as drug administration ，glucose control and hypoglycemic events were included more frequently. D-efficient/ D-optimal and orthogonal experiment designs were used more frequently to create the DCE choice sets. DCE data quality could be checked by the internal validity tests. The rules of thumb was usually used to calculate the sample size. Conditional Logit model ，multinomial Logit model or mixed Logit model were used more frequently to analyze the preference data. ZH187） Compared with mild hypoglycemic events ，patients’treatment E-mail：19111020032@fudan.edu.cn choices were more likely to be affected by blood glucose control. However ， when hypoglycemic events occurred at：yychen@shmu.edu.cn night or the degree of hypoglycemia was serious ， the ·treatment preference of patients would change. Although most studies included the drug administration related attributes ，they were not major factors influencing patients ’treatment preferences and were closely related to patients ’previous medication history. DCE had been widely used in the study of type 2 diabetes in foreign countries ，but there were few relevant studies in China. The data quality of DCE was difficult to control. Although the trend of building complex econometric models was gradually rising ，most studies had not fully introduced the design details such as sample size determination method ，option set design principle and quality control option. In addition ，there were some deficiencies such as too many attributes ，too large or too small horizontal spacing. It is suggested that the ten criteria of related research in ISPOR report by Bridges JF and other soholars can be used for reference in DCE design to improve the rigor of design and ensure the credibility of preference results.

Valuation for cigarettes among University of the Philippines Manila students through stated preference methods

OBJECTIVE:The study aimed to assess the valuation for cigarettes among UP Manila students aged 18-24 through direct and indirect stated preference methods.METHODS: Direct (iterative bidding) and indirect (discrete choice experiment) stated preference methods were utilized to determine the smokers' Willingness-to-Pay (WTP) and non-smokers' Willingness-to-Accept (WTA). Median and interquartile range were used in describing both WTP and WTA. Fisher's Exact Test and T-test were performed using STATA v12 to determine the association between the identified factors.  RESULTS: Of the 212 respondents, 21 (9.91%) were smokers. The smokers' direct and indirect WTP for a cigarette stick were PhP 6.00 and PhP 12.43, respectively. There was a significant difference (p=0.01) between the results of the two methods. Meanwhile, 40.84% of the non-smokers could be induced to smoke with PhP 0.00 as their WTA. No significant association was found between the smokers' stated preference and their smoking status and allowance. The WTP of the smokers was higher than the December 2013 retail prices of cigarettes.CONCLUSION: The increased cigarette prices brought about by the Sin Tax Law were insufficient in stopping the selected UP Manila students to smoke. In addition, forty percent of non-smokers in the study could be induced to smoke. Thus, further price increase of cigarettes, as well as other tobacco control measures, is recommended to discourage smoking among the youth such as college students, specifically in UP Manila.

Job preferences of doctors at township health center：A discrete choice experiment in three provinces of China / 中国卫生政策研究

Objective:To analyze the job preference of doctors at township health center ( THC) and provide references for formulating effective policy. Methods:238 cases of doctors were sampled from Shandong, Anhui and Shaanxi provinces. Using a discrete choice experiment, we analyzed the data with a conditional logit model. Results:The most important job attribution was salary, followed by education for children, permanent post, work location, training opportunity, and years before promotion. The OR value of the monthly income of 8 000 yuan is 7. 0 compared to 2 000 yuan. Doctors will pay 3 857 yuan and 3 294 yuan respectively for better education for children and perma-nent posts. Monthly income increasing to 8 000 yuan will reduce the quitting rate from 35% to 8%, and providing better education for children and permanent posts will reduce 5%. The permanent posts at township health center and non-permanent posts in county hospital have the same appeal to the doctor. Conclusion:When choosing a job, doc-tors at THCs valued salary the most. Improving the education level for children can be beneficial for attracting and re-taining doctors at THCs. A permanent post is more attractive to doctors than non-permanent posts at THCs.

Results from a preliminary study to develop the quality adjustments for quality adjusted life year values for Trinidad and Tobago / Resultados de un estudio preliminar para desarrollar ajustes de calidad para los valores de un año de vida ajustado por calidad en Trinidad y Tobago

OBJECTIVE: No country can afford to provide all necessary healthcare for its citizens, so prioritization among interventions must feature in all health systems. Resources in health should be allocated among interventions/facilities/patients in such a way as to be in line with the objectives of the health system. To achieve this, resource allocation decisions must be informed by the relative contributions that prospective interventions will make to societal health and to costs. Internationally, the EQ-5D based quality adjusted life year (QALY) now dominates this kind of analysis. This paper reports on a pilot study to develop an EQ-5D-3L value set for Trinidad and Tobago based on a protocol that avoids some of the issues that are associated with other approaches to developing such value sets such as the complex elicitation tasks that respondents must carry out, and the large respondent samples required for collecting multiple valuation subset values using blocked designs. METHODS: An orthogonal discrete choice experiment design was used to elicit a set of choices from a sample of respondents. RESULTS: The choice data were analysed using mixed multinomial logistic regression to produce an internally valid model that predicts well. CONCLUSION: This paper marks an important milestone in the development of health resource allocation in the Caribbean. It sets out the importance of incorporating the impact of health interventions to inform health resource allocation decisions, describes the elicitation and analysis methods used in the pilot and provides an illustration ofthe use ofthe EQ-5D value set.

OBJETIVO: Ningún país puede permitirse ofrecer toda la atención a la salud necesaria para sus ciudadanos, de modo que la necesidad de establecer prioridades en las intervenciones constituye un rasgo característico de todos los sistemas de salud. Los recursos de salud deben asignarse entre las intervenciones/instalaciones/pacientes de tal manera que se correspondan con los objetivos del sistema de salud. Para lograr esto, las decisiones en cuanto a la asignación de recursos deben reportarse en términos de las contribuciones relativas que las intervenciones prospectivas representarán para la salud social y los costos. Internacionalmente, el EQ - 5D basado en el año de vida ajustado por calidad (AVAC), domina ahora este tipo de análisis. El presente trabajo reporta un estudio piloto para desarrollar un conjunto de valores EQ - 5D - 3L para Trinidad y Tobago, basado en un protocolo que evite algunos de los problemas asociados con otros enfoques usados para desarrollar estos conjuntos de valores, tales como tareas complejas de obtención de datos, que los encuestados tienen que llevar a cabo, y las grandes muestras de respuestas requeridas para recoger varios subconjuntos de valoración múltiple utilizando diseños bloqueados. MÉTODOS: Un diseño de experimento de elección discreta ortogonal se utiliza para obtener un conjunto de opciones de una muestra de encuestados. RESULTADOS: Los datos de la elección se analizaron mediante regresión logística multinomial mixta para producir un modelo internamente válido que predice bien. CONCLUSION: Este documento marca un hito importante en el desarrollo de la asignación de recursos de salud en el Caribe. El mismo establece la importancia de incorporar el impacto de las intervenciones de salud para informar las decisiones de asignación de recursos de salud, describe los métodos de obtención y análisis utilizados en el programa piloto, y proporciona una ilustración del uso del conjunto de valores EQ - 5D.