Preferences for the emergency department or alternatives for older people in aged care: a discrete choice experiment.
To estimate the effect of factors that influence decisions to transfer residents of aged care facilities to an emergency department (ED) for acute medical emergencies.



A discrete choice experiment with residents (N = 149), the relatives of residents (N = 137) and staff members (N = 128) of aged care facilities.



Aged care facilities in three Australian states.



Using random parameter logit models, parameter estimates and odds ratios were estimated, and resultant utility functions for ED and alternate care were constructed.



All attributes (including waiting time, complication rates, symptom relief and time spent alone) significantly influence choice for accessing acute care. There is a strong overall preference for ED care (odds ratio 1.73, 95% confidence interval 1.57–1.92), but this varies by clinical scenario, being the strongest for pneumonia and weakest for wrist fracture. Relatives of residents were less tolerant of reductions in care quality than staff members or residents themselves.



Underlying preference for ED transfer of aged care facility residents in acute medical emergencies is strong and independent of commonly used quality of care measures.
University of Western Australia, Crawley, Western Australia 6008, Australia.
Glenn
G
Arendts
The George Institute for Global Health, University of Sydney, New South Wales, Australia.
Stephen
S
Jan
Institute of Transport and Logistics Studies, Business School, University of Sydney, New South Wales, Australia.
Matthew J
MJ
Beck
The University of Sydney, Sydney School of Public Health, Sydney, New South Wales, Australia.
Kirsten
K
Howard
D000058:Accidental Falls; D001291:Attitude of Health Personnel; D002637:Chest Pain / Q000175:diagnosis / Q000628:therapy; D002755:Choice Behavior; D019033:Delivery of Health Care, Integrated; D004417:Dyspnea / Q000175:diagnosis / Q000628:therapy; D004636:Emergency Service, Hospital; D005190:Family / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006707:Homes for the Aged; D006801:Humans; D016015:Logistic Models; D009735:Nursing Homes; D016017:Odds Ratio; D057240:Patient Preference; D017060:Patient Satisfaction; D010360:Patient Transfer; D011787:Quality of Health Care; D012074:Remission Induction; D013997:Time Factors; D061665:Time-to-Treatment; D000078329:Workforce; D014954:Wrist Injuries / Q000175:diagnosis / Q000628:therapy