title: Patient Preferences for Features of Health Care Delivery Systems: A Discrete Choice Experiment.
abstract: OBJECTIVE
  To estimate the relative importance of organizational-, procedural-, and interpersonal-level features of health care delivery systems from the patient perspective.
  
  
  METHODS
  We designed four discrete choice experiments (DCEs) to measure patient preferences for 21 health system attributes. Participants were recruited through the online patient portal of a large health system. We analyzed the DCE data using random effects logit models.
  
  
  METHODS
  DCEs were performed in which respondents were provided with descriptions of alternative scenarios and asked to indicate which scenario they prefer. Respondents were randomly assigned to one of the three possible health scenarios (current health, new lung cancer diagnosis, or diabetes) and asked to complete 15 choice tasks. Each choice task included an annual out-of-pocket cost attribute.
  
  
  RESULTS
  A total of 3,900 respondents completed the survey. The out-of-pocket cost attribute was considered the most important across the four different DCEs. Following the cost attribute, trust and respect, multidisciplinary care, and shared decision making were judged as most important. The relative importance of out-of-pocket cost was consistently lower in the hypothetical context of a new lung cancer diagnosis compared with diabetes or the patient's current health.
  
  
  CONCLUSIONS
  This study demonstrates the complexity of patient decision making processes regarding features of health care delivery systems. Our findings suggest the importance of these features may change as a function of an individual's medical conditions.
authors.affiliation: Hochschule Neubrandenburg, Brodaer Straße 2, Neubrandenburg, Germany.|Institute of Health Economics and Health Care Management, Neubrandenburg University of Applied Sciences, Neubrandenburg, Germany.|Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
authors.forename: Axel C
authors.initials: AC
authors.lastname: Mühlbacher
authors.affiliation: Institute of Health Economics and Health Care Management, Neubrandenburg University of Applied Sciences, Neubrandenburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Bethge
authors.affiliation: Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
authors.forename: Shelby D
authors.initials: SD
authors.lastname: Reed
authors.affiliation: Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Schulman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002755:Choice Behavior; D003657:Decision Making; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000191:economics / Q000628:therapy; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010358:Patient Participation; D057240:Patient Preference / Q000706:statistics & numerical data*; D035502:Trust; D055815:Young Adult
keywords: Patient preference; choice behavior; delivery of health care; discrete choice models