A comparison of five multi attribute utility instruments

Abstract This paper presents the results of the validation study carried out to evaluate the Assessment of Quality of Life (AQoL) Instrument for the measurement of health related quality of life and utility. It involves, inter alia, the largest comparison of utility instruments that has been carried out to date. The five instruments included in the study are the AQoL, the Canadian HUI III, the Finnish 15D, the EuroQoL (EQ5D) and the SF36 with UK utility weights as quantified by Brazier (1998). The paper compares: (i) the absolute utility score obtained by different sub-populations; (ii) instrument sensitivity; (iii) the incremental differences in utility between different health states; (iv) the structural properties of descriptive systems; and (v) a limited comparison with a Time Trade-Off (TTO) assessment of own health by individuals. Using these criteria the AQoL performs very well. Its predicted utilities are very similar to those obtained from the HUI. There is evidence that the AQoL has greater sensitivity to health states than other instruments and its psychometric properties, as usually judged, are excellent. Despite this, it is concluded that, at present, no single MAU system can claim to be the gold standard and that researchers should select an instrument that is sensitive to the health states which they are investigating and that caution should be exercised in treating any of the instrument results as representing a utility score which truly represents a trade-off between life and health related quality of life

The Impact of English Language Proficiency and Workplace Readiness on the Employment Outcomes of Tertiary International Students (Full Report)

This project examines the influence of English language proficiency (ELP) on workplace readiness and employment outcomes for international students and graduates who seek to work in Australia. The study adopts a mixed method approach involving a detailed review of relevant literature, semi-structured individual interviews and focus groups, and quantitative analyses of three statistical data sets — Australian 2006 Census data, Australian Education International (AEI) data from January 2002 to June 2008, and the former Department of Immigration and Multicultural and Indigenous Affairs (DIMIA) Longitudinal Survey of Immigrants to Australia (October 2005 and October 2006). The qualitative data from the interviews enabled the authors to analyse the topic of investigation from several different perspectives including those of: international students and graduates; local (permanent resident or citizen) students and graduates; representatives of tertiary institutions and VET providers; recent offshore graduate job seekers with overseas qualifications; and Australian employers and regulatory bodies in five professional and three trade fields. The findings show that international students employment outcomes are not as good as their Australian domestic counterparts and that they face greater challenges in finding full-time employment after graduation. While ELP is a key factor influencing their employment outcomes — particularly if graduates have low levels of ELP — the findings from this study show that ELP is not the only or principal issue. Employers\u27 first priority is to engage graduates with strong profession-specific skills and then to consider their ‘well-roundedness’. The ‘well-roundedness’ includes graduates’ personal characteristics and attributes, the diversity of their experiences and skills, as well as their ‘cultural fit’ into the workplace. There is potential to respond to this expectation through policies and practices that support integrated approaches for enhancing ELP and workplace readiness within educational institutions, as well as increasing international students’ awareness of the value of the experiences and skills they can develop outside of their studies

The Impact of English Language Proficiency and Workplace Readiness on the Employment Outcomes of Tertiary International Students (Executive Summary)

This project examines the influence of English language proficiency (ELP) on workplace readiness and employment outcomes for international students and graduates who seek to work in Australia. The study adopts a mixed method approach involving a detailed review of relevant literature, semi-structured individual interviews and focus groups, and quantitative analyses of three statistical data sets — Australian 2006 Census data, Australian Education International (AEI) data from January 2002 to June 2008, and the former Department of Immigration and Multicultural and Indigenous Affairs (DIMIA) Longitudinal Survey of Immigrants to Australia (October 2005 and October 2006). The qualitative data from the interviews enabled the authors to analyse the topic of investigation from several different perspectives including those of: international students and graduates; local (permanent resident or citizen) students and graduates; representatives of tertiary institutions and VET providers; recent offshore graduate job seekers with overseas qualifications; and Australian employers and regulatory bodies in five professional and three trade fields. The findings show that international students employment outcomes are not as good as their Australian domestic counterparts and that they face greater challenges in finding full-time employment after graduation. While ELP is a key factor influencing their employment outcomes — particularly if graduates have low levels of ELP — the findings from this study show that ELP is not the only or principal issue. Employers\u27 first priority is to engage graduates with strong profession-specific skills and then to consider their ‘well-roundedness’. The ‘well-roundedness’ includes graduates’ personal characteristics and attributes, the diversity of their experiences and skills, as well as their ‘cultural fit’ into the workplace. There is potential to respond to this expectation through policies and practices that support integrated approaches for enhancing ELP and workplace readiness within educational institutions, as well as increasing international students’ awareness of the value of the experiences and skills they can develop outside of their studies

The Impact of English Language Proficiency and Workplace Readiness on the Employment Outcomes of Tertiary International Students (Executive Summary)

This project examines the influence of English language proficiency (ELP) on workplace readiness and employment outcomes for international students and graduates who seek to work in Australia. The study adopts a mixed method approach involving a detailed review of relevant literature, semi-structured individual interviews and focus groups, and quantitative analyses of three statistical data sets — Australian 2006 Census data, Australian Education International (AEI) data from January 2002 to June 2008, and the former Department of Immigration and Multicultural and Indigenous Affairs (DIMIA) Longitudinal Survey of Immigrants to Australia (October 2005 and October 2006). The qualitative data from the interviews enabled the authors to analyse the topic of investigation from several different perspectives including those of: international students and graduates; local (permanent resident or citizen) students and graduates; representatives of tertiary institutions and VET providers; recent offshore graduate job seekers with overseas qualifications; and Australian employers and regulatory bodies in five professional and three trade fields. The findings show that international students employment outcomes are not as good as their Australian domestic counterparts and that they face greater challenges in finding full-time employment after graduation. While ELP is a key factor influencing their employment outcomes — particularly if graduates have low levels of ELP — the findings from this study show that ELP is not the only or principal issue. Employers\u27 first priority is to engage graduates with strong profession-specific skills and then to consider their ‘well-roundedness’. The ‘well-roundedness’ includes graduates’ personal characteristics and attributes, the diversity of their experiences and skills, as well as their ‘cultural fit’ into the workplace. There is potential to respond to this expectation through policies and practices that support integrated approaches for enhancing ELP and workplace readiness within educational institutions, as well as increasing international students’ awareness of the value of the experiences and skills they can develop outside of their studies

Measuring patient satisfaction with urinary incontinence treatment

Background: A number of patient satisfaction measures were trialed in a cross-sectional survey of women who had treatment for urinary incontinence (N=187). The psychometric properties of these measures were examined and a short measure for patient satisfaction was developed. Methods: Participants completed a questionnaire comprising items covering incontinence status, treatment type and three generic patient satisfaction questionnaires: the Client Satisfaction Questionnaire (CSQ-18), the Consultation Satisfaction Questionnaire (Consult SQ), and the Patient Satisfaction Index (PSI). Donabedian\u27s model postulates that satisfaction is the patient\u27s judgment on the quality of care. The seven dimensions in this model provide the conceptual framework against which the measures were reviewed. Results: The instruments were examined by their descriptive systems, internal structures and responsiveness. The items from the instruments were examined through iterative Mokken and partial credit IRT analyses against Donabedian\u27s model. Seven items were selected which formed a Short Assessment of Patient Satisfaction (SAPS) scale. Its internal psychometric properties were excellent (α = 0.86) and it provided a patient satisfaction perspective that was most consistent with Donabedian\u27s model. In summary, the internal structures of the instruments suggested that all SAPS items were responsive, but some items on the other measures were insensitive. Also, all measures were shown to be unidimensional. Tests of response bias suggested that this was present in the CSQ-18 and the PSI. Redundancy was observed in the Consult SQ, CSQ-18 and PSI. Conclusions: This study has provided evidence that patient satisfaction can be assessed validly, reliably and sensitively using the much shorter SAPS instrument. This new short measure of patient satisfaction with treatment will be a useful tool for clinicians and evaluators as the population ages

The Friendship Scale: Development and properties

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Relationship between health-related quality of life and, acute care readmissions and survival in older adults with chronic illness

BACKGROUND: Australia's ageing population means that there is increasing emphasis on developing innovative models of health care delivery for older adults. The assessment of the most appropriate mix of services and measurement of their impact on patient outcomes is challenging. The aim of this evaluation was to describe the health related quality of life (HRQoL) of older adults with complex needs and to explore the relationship between HRQoL, readmission to acute care and survival. METHODS: The study was conducted in metropolitan Melbourne, Australia; participants were recruited from a cohort of older adults enrolled in a multidisciplinary case management service. HRQoL was measured at enrolment into the case-management service using The Assessment of Quality of Life (AQoL) instrument. In 2007-2009, participating service clinicians approached their patients and asked for consent to study participation. Administrative databases were used to obtain data on comorbidities (Charlson Comorbidity Index) at enrolment, and follow-up data on acute care readmissions over 12 months and five year mortality. HRQoL was compared to aged-matched norms using Welch's approximate t-tests. Univariate and multivariate logistic regression models were used to explore which patient factors were predictive of readmissions and mortality. RESULTS: There were 210 study participants, mean age 78 years, 67% were female. Participants reported significantly worse HRQoL than age-matched population norms with a mean AQOL of 0.30 (SD 0.27). Seventy-eight (38%) participants were readmitted over 12-months and 5-year mortality was 65 (31%). Multivariate regression found that an AQOL utility score <0.37 (OR 1.95, 95%CI, 1.03 - 3.70), and a Charlson Comorbidity Index ≥6 (OR 4.89, 95%CI 2.37 - 10.09) were predictive of readmission. Multivariate analysis demonstrated that age ≥80 years (OR 7.15, 95%CI, 1.83 - 28.02), and Charlson Comorbidity Index ≥6 (OR 6.00, 95%CI, 2.82 - 12.79) were predictive of death. CONCLUSION: This study confirms that the AQoL instrument is a robust measure of HRQoL in older community-dwelling adults with chronic illness. Lower self-reported HRQoL was associated with an increased risk of readmission independently of comorbidity and kind of service provided, but was not an independent predictor of five-year mortality

Construction of the descriptive system for the assessment of quality of life AQoL-6D utility instrument

BackgroundMulti attribute utility (MAU) instruments are used to include the health related quality of life (HRQoL) in economic evaluations of health programs. Comparative studies suggest different MAU instruments measure related but different constructs. The objective of this paper is to describe the methods employed to achieve content validity in the descriptive system of the Assessment of Quality of Life (AQoL)-6D, MAU instrument.MethodsThe AQoL program introduced the use of psychometric methods in the construction of health related MAU instruments. To develop the AQoL-6D we selected 112 items from previous research, focus groups and expert judgment and administered them to 316 members of the public and 302 hospital patients. The search for content validity across a broad spectrum of health states required both formative and reflective modelling. We employed Exploratory Factor Analysis and Structural Equation Modelling (SEM) to meet these dual requirements.Results and DiscussionThe resulting instrument employs 20 items in a multi-tier descriptive system. Latent dimension variables achieve sensitive descriptions of 6 dimensions which, in turn, combine to form a single latent QoL variable. Diagnostic statistics from the SEM analysis are exceptionally good and confirm the hypothesised structure of the model.ConclusionsThe AQoL-6D descriptive system has good psychometric properties. They imply that the instrument has achieved construct validity and provides a sensitive description of HRQoL. This means that it may be used with confidence for measuring health related quality of life and that it is a suitable basis for modelling utilities for inclusion in the economic evaluation of health programs.<br /

The assessment of quality of life (AQoL) instrument construction, initial validation & utility scaling

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The Australian Quality Of Life (AQoL) Instrument: Initial Validation

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