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Exploring Comparative Effectiveness and Efficiency in Long-term Care

To meet societal and economic challenges, health and care welfare regimes will need to become much more focused on the outcomes that matter to people and deliver these programmes effectively and efficiently. Central to this goal is the need to accurately measure outcomes and reflect the value of those outcomes. We measured outcomes in the field of long-term care (LTC) accross three countries. We used a care-related outcome tool, ASCOT, to assess the comparative effectiveness and efficiency of non-institutional LTC (e.g. home care) for older adults and their informal carers in Austria, England and Finland.

Aims and selected results of the EXCELC-Project:

1: Establish valid survey instruments for international comparisons of LTC-outcomes in non-institutional settings, by developing rigorously translated and tested versions of ASCOT.

In total, 4 ASCOT survey instruments were translated into German and Finnish and validated.

ASCOT - for care service users and ASCOT-Carer for informal carers are both available in a version for personal standardized interviews and as a self-completion tool.

For information on the German version of ASCOT and how to obtain a license to use the German version of ASCOT, see here: https://www.wu.ac.at/en/altersoekonomie/ascot

Further information can also be found here: https://www.pssru.ac.uk/ascot/translations/

2: Generate country-specific ASCOT preference weights and explore variations in preferences for ASCOT quality of life domains across countries.

Preference weights for Austria:


Hajji, Assma; Trukeschitz, Birgit; Malley, Juliette; Batchelder, Laurie; Saloniki, Eirini; Linnosmaa, Ismo; Lu, Hui. 2020. Population-​based preference weights for the Adult Social Care Outcomes Toolkit (ASCOT) for service users for Austria: Findings from a best-​worst experiment. Social Science and Medicine. 250 (112792), 1-10. https://www.sciencedirect.com/science/article/pii/S0277953620300113?via%3Dihub

Preference weights for England (ASCOT-Carer):

Batchelder, Laurie, Malley, Juliette, Burge, Peter, Lu, Hui, Saloniki, Eirini-Christina, Linnosmaa, Ismo, Trukeschitz, Birgit, Forder, Julien. 2019. Carer Social Care-Related Quality of Life Outcomes: Estimating English Preference Weights for the Adult Social Care Outcomes Toolkit for Carers. Value in Health. 22 (12), 1427-1440.  - https://www.sciencedirect.com/science/article/pii/S109830151932337X

Comparison of different methods for eliciting preference weights

Saloniki, Eirini-Christina, Malley, Juliette, Burge, Peter, Lu, Hui, Batchelder, Laurie, Linnosmaa, Ismo, Trukeschitz, Birgit, Forder, Julien.2019. Comparing internet and face-to-face surveys as methods for eliciting preferences for social care-related quality of life: evidence from England using the ASCOT service user measure. Quality of Life Research. 28 2207-2220.  https://link.springer.com/article/10.1007/s11136-019-02172-2

3: Explore variations in ASCOT-quality of life (QoL) within and between countries, providing evidence on QoL for service users, carers and the relationship between them, as well as QoL inequalities.

We conducted personalised standardised interviews using ASCOT and ASCOT-Carer in Finland and Austria. We added data collected for England in a previous project.

In total, more than 600 older people were interviewed in Austria who received home care services. In addition, interviews were conducted with more than 300 informal carers

Overview of the results for Austria – care service users and informal carers – in German only:

Trukeschitz, Birgit, Hajji, Assma, Litschauer, Judith, Kieninger, Judith, Linnosmaa, Ismo. 2018. Wie wirken sich Pflegedienste auf die Lebensqualität aus? [The effects of care services on quality of life] Trendreport 1/2018, 20.06.18 https://www.wu.ac.at/fileadmin/wu/d/ri/altersoekonomie/Trendreport_1_2018_ASCOT.pdf

In addition, the effects of mobile care were investigated. The focus was on the change in the quality of life of care service users and informal carers induced by home care services. We looked at characteristics of the service users, their environment and home care services. We found overall and country-specific effects that may inform policy makers on how to improve their care systems.

4: Explore and compare the relative costs, efficiency and cost-effectiveness of specific LTC services. We used econometric methods, combining estimates of the effect of services on QoL and service cost.

This study should strengthen the research base and help guide policymakers and practitioners to make outcomes-focused, economically-sound decisions about LTC. It will also provide useful tools for future evaluations.

Project duration: 1.4.2015-31.8.2018

Extension of the project duration for publications until 30.06.2022

Funding: The project EXCELC is part of the NORFACE programm (New Opportunities for Research Funding Agency Cooperation in Europe) for “Welfare State Futures”. It is funded by NORFACE Coordination Office mit Mitteln aus dem 7. Forschungsrahmenprogramm. Additional funding for Austria is provided by FWF (Fonds zur Förderung der wissenschaftlichen Forschung) and FSW (Fonds Soziales Wien), for Finnland by the National Institute for Health and Welfare.

Team :

Dr. Birgit Trukeschitz – project coordination „EXCELC-Austria“ Contact

Assma Hajji

Judith Kieninger

Judith Litschauer

Univ.Prof. Dr. Ulrike Schneider

Adiam Schoch, BA

EXCELC - project partners:

Prof. Julien Forder (coordination and lead of AP4), Personal Social Service Research Unit, University of Kent, England

Juliette Malley (lead of data collection), Personal Social Service Research Unit, London School of Economics and Political Science, England

Prof. Ismo Linnosmaa (lead Team Finnland and AP1), Center for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finnland

Dr. Birgit Trukeschitz (lead Team Austria and AP3), Forschungsinstitut für Altersökonomie, Wirtschaftsuniversität Wien, Austria

For further information see: http://www.excelc.eu/