Han Boter

Development and measurement properties of the self assessment version of the INTERMED for the elderly to assess case complexity

OBJECTIVES The INTERMED for the Elderly Self Assessment (IM-E-SA) was developed to support health care professionals in providing demand driven elderly care. It assesses case complexity and health care needs as perceived by older adults themselves. By applying this instrument tailored care can be provided as it supports professionals in their allocation decisions. The aim was to evaluate the measurement properties of the IM-E-SA. METHODS In this cross-sectional study 338 elderly people completed a postal questionnaire and participated in an interview. Feasibility of the IM-E-SA was assessed by determining the percentages of missing values per item. Reliability of the IM-E-SA was expressed as Cronbachs alpha. Intraclass correlation coefficients (ICCs) were calculated between the IM-E-SA and IM-E. Nonparametric tests were applied to assess if the IM-E-SA could distinguish between subgroups of elderly adults who differed on demographic characteristics and the prevalence of diseases/disorders. Convergent validity and discriminant validity were assessed using Spearman rank correlations between the IM-E-SA and IM-E, life satisfaction (Cantrils Ladder of Life), activities of daily living (Katz extended), quality of life (EQ-5D), mental health (SF-36) and prevalence of diseases/disorders. RESULTS Percentages of missing values per IM-E-SA item ranged from 0 to 5%. Cronbachs alpha was .78. The ICC between the total scores of the IM-E-SA and the IM-E was .68. The IM-E-SA yielded statistically significant differences between subgroups (known-group validity). Correlations evaluating the convergent validity were moderate to strong (.50-.70). Those correlations assessing the discriminant validity were moderate (.38-.53). CONCLUSION This study supports the feasibility, reliability and validity of the IM-E-SA.

The influence of age on health valuations: the older olds prefer functional independence while the younger olds prefer less morbidity

Background To assess the effectiveness of geriatric interventions, The Older Persons and Informal Caregivers Survey – Composite Endpoint (TOPICS-CEP) has been developed based on health valuations of older persons and informal caregivers. This study explored the influence of the raters’ age on the preference weights of TOPICS-CEP’s components. Methods A vignette study was conducted with 200 raters (mean age ± standard deviation: 72.5±11.8 years; 66.5% female). Profiles of older persons were used to obtain the preference weights for all TOPICS-CEP components: morbidity, functional limitations, emotional well-being, pain experience, cognitive functioning, social functioning, self-perceived health, and self-perceived quality of life. The raters assessed the general wellbeing of these vignettes on a 0–10 scale. Mixed linear regression analysis with interaction terms was used to explore the effects of raters’ age on the preference weights. Results Interaction effects between age and the TOPICS-CEP components showed that older raters gave significantly (P<0.05) more weight to functional limitations and social functioning and less to morbidities and pain experience, compared to younger raters. Conclusion Researchers examining effectiveness in elderly care need to consider the discrepancies between health valuations of younger olds and older olds when selecting or establishing outcome measures. In clinical decision making, health care professionals need to be aware of this discrepancy as well. For this reason we highly recommend shared decision making in geriatric care.

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

BackgroundThe 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.MethodsA 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).ResultsThe 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).ConclusionA 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.

Predictive validity of a frailty measure (GFI) and a case complexity measure (IM-E-SA) on healthcare costs in an elderly population

OBJECTIVES Measures of frailty (Groningen Frailty Indicator, GFI) and case complexity (INTERMED for the Elderly, IM-E-SA) may assist healthcare professionals to allocate healthcare resources. Both instruments have been evaluated with good psychometric properties. Limited evidence has been published about their predictive validity. Thus, our aim is to evaluate the predictive validity of both instruments on healthcare costs. METHODS Multivariate linear regression models were developed to estimate associations between the predictors frailty (GFI) and/or case complexity (IM-E-SA) and the healthcare costs (in € log transformed) in the following year. All models were adjusted for demographics and the presence of morbidity. RESULTS In the multivariate regression analyses the continuous scores of the GFI and IM-E-SA remained significant predictors for total healthcare costs. Adjusted βs for GFI and IM-E-SA were respectively 0.14 (95% CI 0.10-0.18) and 0.06 (95% CI 0.04-0.07). The corresponding explained variance (R(2)) for both models was 0.40. Frailty remained a significant predictor of long-term care costs (adjusted β 0.13 [95% CI 0.09-0.16]), while case complexity was a significant predictor of curative care costs (adjusted β 0.03 [95% CI 0.02-0.05]). CONCLUSIONS The GFI and IM-E-SA both accurately predict total healthcare costs in the following year.

Comparing the health state preferences of older persons, informal caregivers and healthcare professionals: a vignette study.

Background The Older Persons and Informal Caregivers Survey—Minimum Dataset (TOPICS-MDS) collects uniform information from research projects funded under the Dutch National Care for the Elderly Programme. To compare the effectiveness of these projects a preference-weighted outcome measure that combined multidimensional TOPICS-MDS outcomes into a composite endpoint (TOPICS-CEP) was developed based on the health state preferences of older persons and informal caregivers. Objectives To derive preference weights for TOPICS-CEP’s components based on health state preferences of healthcare professionals and to investigate whether these weights differ between disciplines and differ from those of older persons and informal caregivers. Materials and Methods Vignette studies were conducted. Participants assessed the general wellbeing of older persons described in vignettes on a scale (0-10). Mixed linear analyses were used to obtain and compare the preference weights of the eight TOPICS-CEP components: morbidities, functional limitations, emotional wellbeing, pain experience, cognitive problems, social functioning, self-perceived health, and self-perceived quality of life (QOL). Results Overall, 330 healthcare professionals, 124 older persons and 76 informal caregivers participated. The preference weights were not significantly different between disciplines. However, the professionals’ preference weights differed significantly from those of older persons and informal caregivers. Morbidities and functional limitations were given more weight by older persons and informal caregivers than by healthcare professionals [difference between preference weights: 0.12 and 0.07] while the opposite was true for pain experience, social functioning, and self-perceived QOL [difference between preference weights: 0.13, 0.15 and 0.26]. Conclusion It is important to recognize the discrepancies between the health state preferences of various stakeholders to (1) correctly interpret results when studying the effectiveness of interventions in elderly care and (2) establish appropriate healthcare policies. Furthermore, we should strive to include older persons in our decision making process through a shared decision making approach.

Examining the construct and known-group validity of a composite endpoint for The Older Persons and Informal Caregivers Survey Minimum Data Set (TOPICS-MDS); A large-scale data sharing initiative

Background Preference-weighted multi-faceted endpoints have the potential to facilitate comparative effectiveness research that incorporates patient preferences. The Older Persons and Informal Caregivers Survey—Composite endpoint (TOPICS-CEP) is potentially a valuable outcome measure for evaluating interventions in geriatric care as it combines multiple outcomes relevant to older persons in a single metric. The objective of this study was to validate TOPICS-CEP across different study settings (general population, primary care and hospital). Methods Data were extracted from TOPICS Minimum Dataset (MDS), a pooled public-access national database with information on older persons throughout the Netherlands. Data of 17,603 older persons were used. Meta-correlations were performed between TOPICS-CEP indexed scores, EuroQol5-D utility scores and Cantril’s ladder life satisfaction scores. Mixed linear regression analyses were performed to compare TOPICS-CEP indexed scores between known groups, e.g. persons with versus without depression. Results In the complete sample and when stratified by study setting TOPICS-CEP and Cantril’s ladder were moderately correlated, whereas TOPICS-CEP and EQ-5D were highly correlated. Higher mean TOPICS-CEP scores were found in persons who were: married, lived independently and had an education at university level. Moreover, higher mean TOPICS-CEP scores were found in persons without dementia, depression, and dizziness with falls, respectively. Similar results were found when stratified by subgroup. Conclusion This study supports that TOPICS-CEP is a robust measure which can potentially be used in broad settings to identify the effect of intervention or of prevention in elderly care.

The feasibility and validity of a preference-weighted composite endpoint to establish value in geriatric care

Background As part of the Dutch National Care for the Elderly Programme, The Older Persons and Informal Caregivers Survey Minimum Data Set (TOPICS-MDS) was developed to gather uniform information on outcome measures. Furthermore, to combine the outcome measures into one single index and to promote comparability between studies, a preference-weighted Composite End Point (called: TOPICS-CEP) was developed [1]. The aim of this study was to validate TOPICS-CEP in a large heterogeneous sample of older persons aged ≥65 years.