Transitional Care Service Preference For Chronic Wounds Inpatients In Tertiary Hospitals Of Two Cities In Shandong Province

Background and ObjectiveInpatients with chronic wounds have a high demand for transitional care service after discharge.However,transitional care in China is in the initial stage,and the patients’accessibility and compliance with nursing service at home and in the community are poor,which is the one of the important causes of slow wound healing.Itis important for patients to understand their preferences for transitional care service to improve patient service accessibility and compliance.However,the preferences of inpatients with chronic wound for transitional care services are still unclear.The discrete choice experiment is one of the most widely used methods to measure patients’ preference.This study aims to analyze the preference weight,the relative importance of attributes,willingness to pay,and patients’characteristics of inpatients with chronic wounds to transitional care services by using a discrete choice experiment.It might be helpful to provide patient-centered care service,improve wound healing outcomes,and improve their quality of life.MethodsConvenience sampling was used to select inpatients with chronic wounds and/or their family members from five tertiary hospitals in two cities of Shandong Province.Discrete choice experiment was employed to measure patients’ preference for transitional care services.First,five important attributes(service provider type,service mode,service provider fixity,service content comprehensiveness,out-of-pocket cost)and corresponding levels were determined through literature review,expert consultation,qualitative interview and other methods.Secondly,we used Ngene software’s D-efficient design to generate 10 choice sets.Each choice set included 3 hypothetical transitions of care service scenarios,and one of the alternatives was an opt-out option.A dominant choice set was manually set for internal validity checking.Finally,the Stata 15.1 software was used to select the conditional logit model and the mixed logit model for discrete choice experiment data analysis.The finalized model was conducted to analyze the relative importance of attributes,the willingness to pay for attributes,and the influence of patient characteristics on preferences in the patients’ self-response data.In addition,the patients’ self-response data and the family members’ answer data were collected for robust estimation,and analyze whether there was a significant change in the patients’ preference.ResultsA total of 68 patients and 43 family members participated in the survey and were included in the final analysis.All of them passed the internal validity test.The median age of the 68 self-responding patients were 63 years old.The median age of the patients reported by 43 family members was 78 years old,and 41.9%of them were completely unable to take care of themselves.The results showed that patients preferred to accept the offered option of transitional wound care services than the opt-out option.The comprehensiveness of service content had no statistical significance of patients’ choice of transitional care services(P>0.05),and the other four attributes had statistical significance on patient preference(P<0.05).Patients preferred specialist physicians,continuous medical staff,door-to-door services,and low out-of-pocket cost of transitional care services.The order of attributes’importance was out-of-pocket cost(58.95%),service provider type(21.51%),service mode(10.00%),service provider fixity(7.54%)and service content comprehensiveness(2.00%).Taking the general practice team as the reference,the patients were willing to pay 49.52 yuan and 47.75 yuan for the wound care provided by specialist physicians and specialist nurses,respectively.The type of service provider and the comprehensiveness of service content did not have statistically significant preference heterogeneity among patients(P>0.05).However,service mode,service provider fixity,out-of-pocket cost,and opt-out options had statistically significant preference heterogeneity among patients(P<0.05).Compared with the patients living in cities,the patients living in rural areas preferred home care provided by medical staff.Conclusions and SuggestionsResearch conclusion:Out-of-pocket cost and service provider type both were the most important attributes affecting patients’ choice.Service mode and service provider fixity had an impact on patient preference.Comprehensiveness of service content was the least important attribute for patients different characteristics of patients affected the heterogeneity of patients’ preferences.Based on the above conclusions,the following suggestions were put forward:(1)From the perspective of policymakers,it is necessary to formulate corresponding strategies to reduce or reimburse the cost of transitional care services after discharge,and reduce the financial burden of patients;(2)From the perspective of medical institution managers,primary medical staff should be sent to the higher-level hospitals for further training.Also,specialist medical staff should be sent to the primary level for consultation or remote guidance to ensure that patients could receive professional wound care services in the community and at home after discharge.Furthermore,it is reasonable to consider the various patient characteristics that influence preferences in order to provide targeted nursing services to meet the individual needs of patients.(3)From the perspective of medical workers,it is considerable to strengthen health education knowledge,training and psychological counseling for patients and their family members,which could enrich the service content of transitional wound care.