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Objectives\ud \ud The development of measures such as the EQ-HWB (EQ Health and Wellbeing) requires selection of items. This study explored the psychometric performance of candidate items, testing their validity in patients, social carer users, and carers.\ud \ud \ud \ud Methods\ud \ud Article and online surveys that included candidate items (N = 64) were conducted in Argentina, Australia, China, Germany, United Kingdom, and the United States. Psychometric assessment on missing data, response distributions, and known group differences was undertaken. Dimensionality was explored using exploratory and confirmatory factor analysis. Poorly fitting items were identified using information functions, and the function of each response category was assessed using category characteristic curves from item response theory (IRT) models. Differential item functioning was tested across key subgroups.\ud \ud \ud \ud Results\ud \ud There were 4879 respondents (Argentina = 508, Australia = 514, China = 497, Germany = 502, United Kingdom = 1955, United States = 903). Where missing data were allowed, it was low (UK article survey 2.3%; US survey 0.6%). Most items had responses distributed across all levels. Most items could discriminate between groups with known health conditions with moderate to large effect sizes. Items were less able to discriminate across carers. Factor analysis found positive and negative measurement factors alongside the constructs of interest. For most of the countries apart from China, the confirmatory factor analysis model had good fit with some minor modifications. IRT indicated that most items had well-functioning response categories but there was some evidence of differential item functioning in many items.\ud \ud \ud \ud Conclusions\ud \ud Items performed well in classical psychometric testing and IRT. This large 6-country collaboration provided evidence to inform item selection for the EQ-HWB measure.

Introduction: Academic detailing (AD) is an educational outreach strategy to provide clinicians with current evidence-based information, which has been shown to change prescribing behaviours. The overall effectiveness of AD interventions is associated with prescriber satisfaction; however, most approaches use single items or nonvalidated measures. This study aims to develop and validate an instrument to assess prescriber satisfaction with AD interventions. Methods: A group of candidate items was generated and refined based on constructs identified through a literature review and in consultation with an expert panel. The initial instrument was piloted with 183 primary care providers who participated in an AD intervention on opioid-related pain management. To support the validity and reliability of the measure, psychometric properties were examined. Results: Ten candidate items were developed based on the following themes: acceptability, feasibility of implementation, usefulness, perception of efficacy, overall satisfaction, willingness to repeat and willingness to change. One item related to willingness to change did not contribute to assessing an individual’s ability and lowered the measure’s internal consistency and was therefore dropped. Conclusion: Results supported the validity and reliability of a refined 9-item measure of Provider Satisfaction with Academic Detailing (the PSAD). This measure should be considered for broad use across educational outreach programmes as a standardized measure to assess provider satisfaction and provide continuous quality improvement.

Resumo Fundamento: Selecionar a estratégia de tratamento ideal para a revascularização coronária é um desafio. Um desfecho crucial a ser considerado no momento dessa escolha é a necessidade de refazer a revascularização, uma vez que ela se torna muito mais frequente após a intervenção coronária percutânea (ICP) do que após a cirurgia de revascularização do miocárdio (CRM). Objetivo: Pretende-se, com este estudo, trazer reflexões acerca das preferências dos pacientes pelas estratégias de revascularização sob a perspectiva de pacientes que tiveram que refazer a revascularização. Métodos: Selecionamos uma amostra de pacientes que haviam sido submetidos à ICP e hospitalizados para refazer a revascularização coronária e elicitamos suas preferências por nova ICP ou CRM. Morte perioperatória, mortalidade a longo prazo, infarto do miocárdio e repetir a revascularização foram utilizados para a construção de cenários a partir da descrição de tratamentos hipotéticos que foram rotulados como ICP ou CRM. A ICP era sempre apresentada como a opção com menor incidência de morte perioperatória e maior necessidade de se refazer o procedimento. O modelo logístico condicional foi empregado para analisar as escolhas dos pacientes, utilizando-se o software R. Valores de p

The EQ Health and Wellbeing Short (EQ-HWB-S) is a new broad generic measure of health and wellbeing for use in economic evaluations of interventions across healthcare, social care, and public health. This measure conceptually overlaps with the 5-level version EQ-5D (EQ-5D-5L), while expanding on the coverage of health and social care related dimensions. This study aims to examine the extent to which the EQ-HWB-S and EQ-5D-5L overlap and are different.A sample of US-based respondents (n = 903; n = 400 cancer survivors and n = 503 general population) completed a survey administered via an online panel. The survey included the EQ-HWB item pool (62 items, including 11 items used in this analysis), EQ-5D-5L, and questions about sociodemographic and health characteristics. The analysis included (Spearman's) correlations, the comparison of patterns of response (distributions and ceiling effects), and the ability to discriminate between known groups.Moderate to strong associations were found between conceptually overlapping dimensions of the EQ-5D-5L and the EQ-HWB-S (rResults indicate a convergence between the measures, especially between overlapping dimensions, lending support to the validity of the EQ-HWB-S. The EQ-HWB-S performed similarly or better than the EQ-5D-5L among patient groups and is better able to differentiate among caregivers and respondents closer to full health.

Background Quality of life has become a key outcome in assessing the effectiveness of treatments and interventions in health. Methods Accordingly, this research study aimed to measure quality of life using the EQ-5D-3L instrument for patients from the Jamil Haddad National Institute of Traumatology and Orthopedics (Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad – INTO) with femoral fractures, hospitalized between 11/2015 and 10/2016. Results A total of 165 orthopedic trauma patients with femoral fractures, aged 18 years or older, who were hospitalized and operated upon in the INTO were assessed. The assessment instruments were applied at admission and in the first and second follow-up visits to the outpatient clinic. Most study subjects were women and older than 60 years. Proximal femoral fracture was the most commonly found fracture. The Visual Analog Scale (VAS) assessments over the study period showed an increasing gain in self-assessed quality of life. Similarly, the EQ-5D-3L showed significant improvements in quality of life assessed in the five dimensions of the instrument: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Conclusion This type of assessment may help in decision-making and cost-utility assessments related to orthopedic trauma.

Carlos Alberto da Silva Magliano,1 Andrea Liborio Monteiro,2 Bernardo Rangel Tura,1 Claudia Silvia Rocha Oliveira,1 Amanda Rebeca de Oliveira Rebelo,1 Claudia Cristina de Aguiar Pereira3 1NATS, Instituto Nacional de Cardiologia, INC, Rio de Janeiro, Rio de Janeiro, Brazil; 2Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA; 3Escola Nacional de Saúde Pública, ENSP, FIOCRUZ, Rio de Janeiro, Brazil Purpose: Communicating information about risk and probability to patients is considered a difficult task. In this study, we aim to evaluate the use of visual aids representing perioperative mortality and long-term survival in the communication process for patients diagnosed with coronary artery disease at the National Institute of Cardiology, a Brazilian public hospital specializing in cardiology. Patients and methods: One-on-one interviews were conducted between August 1 and November 20, 2017. Patients were asked to imagine that their doctor was seeking their input in the decision regarding which treatment represented the best option for them. Patients were required to choose between alternatives by considering only the different benefits and risks shown in each scenario, described as the proportion of patients who had died during the perioperative period and within 5 years. Each participant evaluated the same eight scenarios. We evaluated their answers in a qualitative and quantitative analysis. Results: The main findings were that all patients verbally expressed concern about perioperative mortality and that 25% did not express concern about long-term mortality. Twelve percent considered the probabilities irrelevant on the grounds that their prognosis would depend on “God’s will.” Ten percent of the patients disregarded the reported likelihood of perioperative mortality, deciding to focus solely on the “chance of being cured.” In the quantitative analysis, the vast majority of respondents chose the “correct” alternatives, meaning that they made consistent and rational choices. Conclusion: The use of visual aids to present risk attributes appeared feasible in our sample. The impact of heuristics and religious beliefs on shared health decision making needs to be explored better in future studies. Keywords: patients’ preferences, coronary revascularization, angina, cardiology, coronary artery bypass grafting, percutaneous coronary intervention

Introduction Academic detailing (AD) is an effective, evidence-based education outreach method of promoting clinician behavior change. Detailer feedback is important for program evaluation but is rarely systematically collected. The study's objective was to develop a measure capturing the detailer's perception of the effectiveness of an AD program. Methods A six-item measure with a five-level scale was initially developed from the literature review and expert panel consultation. Item constructs were usefulness, acceptability, feasibility, relevance, effectiveness of communication, and readiness to change. The measure was piloted, refined, and tested during an opioid-focused AD program that included two visits. The instrument structure was evaluated using exploratory factor analysis, measure reliability was assessed using item-item correlation (rho), corrected item-total correlation, Cronbach alpha (α), and item response theory. Results The initial six-item instrument demonstrated unidimensionality. The Cronbach α for the measure was 0.74 (visit 1) and 0.79 (visit 2); one item (relevance) was redundant (α = 0.73 and 0.79 when deleted) and therefore dropped. Items related to usefulness, acceptability, and readiness to change displayed high item-item correlation (rho ≥ 0.50) and contributed the most information and seemed to operate as a single scale (ie, "likelihood to change") based on item response theory analysis. Items related to feasibility and communication were slightly different constructs and should be reported separately. Discussion The five-item detailer assessment of visit effectiveness (the "DAVE") instrument provides a standardized approach to assess AD. Further study of its validity and broader use in other programs and educational outreach activities is encouraged.

BACKGROUND Information about how individual characteristics influence preferences about health states valuation are scare. The purpose of this study is to identify predictors of the EuroQol with five dimensions and 3 levels - EQ 5D-3L time-tradeoff valuation. RESEARCH DESIGN AND METHODS We analyzed a dataset with a probabilistic sample of 5774 individuals. Two sets of independent variables for testing were defined: a set of forced variables composed of 10 dummy variables for EuroQol levels 2 and 3 of each health dimension and a set of demographic variables. RESULTS The strongest predictors of health valuation were the self-reported health state and the 'belief in God,' with 0.11 utility units for each VAS unit and 0.11 utility units for 'yes' for the 'belief in God' parameter.Age had an impact of 0.0190 utility units for each 10-year interval. Having children had a small effect (0.0338 utility units for 'yes'), and the other characteristics studied had no significant impact. CONCLUSIONS People who believe in God (or the afterlife) and those of greater age seem to be less prone to forgoing life years to avoid health problems. In our sample, older individuals valued health state higher than younger individuals.

Aims Current recommendations regarding the best treatment option for coronary revascularization are usually based on composite outcomes that were not selected or weighed with patients thence they may fail in representing patients' preferences adequately. This systematic review aimed to appraise existing literature surrounding stated preference (SP) regarding coronary revascularization. Methods and results Studies related to SP regarding coronary revascularization were searched on Medline, Embase and Lilacs databases. Two reviewers screened all titles independently, and consensus resolved any disagreements. Of 735 total citations, six studies were included and qualitatively synthesized. Notably, the attributes most often cited in these studies coincided with those already used in clinical trials (death, myocardial infarction, stroke and redo revascularization). Half of the studies analyzed the use of composite endpoints and showed the necessity to review this practice since the attributes are weighed differently, and there is a disagreement between patients and physicians. Also, a large variety of methods were used to elicitate and value the attributes such as rating, ranking, standard gamble, willingness to pay, and discrete choice experiments. Conclusion Despite a large number of studies comparing revascularization treatment efficacy, there are just a few focusing on patients' preferences. The selection of outcomes to be considered in the trade-off between treatment options and how to weigh them properly, taking into consideration patients' preferences, need to be explored in future trials.

Carlos Alberto da Silva Magliano,1 Andrea Liborio Monteiro,2 Bernardo Rangel Tura,1 Claudia Silvia Rocha Oliveira,1 Amanda Rebeca de Oliveira Rebelo,1 Claudia Cristina de Aguiar Pereira3 1HTA Department, National Institute of Cardiology, Rio de Janeiro, Brazil; 2Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA; 3The National School of Public Health Sergio Arouca ENSP/Fiocruz, Rio de Janeiro, Brazil Background: Patients with a diagnosis of coronary artery disease (CAD) may face important decisions regarding treatment options, with the “right choice” depending on the relative weights of risks and benefits. Studies performed as discrete choice experiments are used to estimate these weights, and attribute selection is an essential step in the design of these studies. Attributes not included in the design cannot be analyzed. In this study, we aimed to elicit, rank, and rate attributes that may be considered important to patients and physicians who must choose between angioplasty and surgery for coronary revascularization. Methods: The elicitation process involved performing a systematic review to search for attributes cited in declared preference studies in addition to face-to-face interviews with cardiologists and experts. The interviews were audio-recorded in digital format, and the collected data were transcribed and searched to identify new attributes. The criterion used to finish the data collection process was sampling saturation. Results: A systematic review resulted in the selection of the following 14 attributes: atrial fibrillation, heart failure, incision scar, length of stay, long-term survival, myocardial infarction, periprocedural death, postoperative infection, postprocedural angina, pseudoaneurysm, renal failure, repeat coronary artery bypass grafting, repeat percutaneous coronary intervention, and stroke. The interviews added no new attributes. After rating, we identified significant differences in the values that patients and cardiologists placed on renal insufficiency (p

Background. Most EQ-5D-3L valuation studies include the same sample of health states that was used in the protocol of the original UK Measurement and Valuation of Health (MVH) study. Thus far, no studies using a time tradeoff utility elicitation method have been carried out using all 243 EQ-5D health states. Because the values and preferences regarding health outcomes differ among countries, it is essential to have country-specific data to enable local high-level decisions regarding resource allocation. This study developed a country-specific set of values for EQ-5D-3L health states. Methods. A multicentric study was conducted in 4 Brazilian areas. A probabilistic sample of the general population, aged 18 to 64 y, stratified by age and gender, was surveyed. The interview followed a revised version of the MVH protocol, in which all 243 health states were valued. Each respondent ranked and valued 7 health states using the TTO in a home interview. Results. Data were collected from 9148 subjects. The best-fitting regression model was an individual-level mixed-effects model without any interaction terms. The dimensions “Mobility” and “Usual Activities” were associated with higher losses in health state utility value. The “Anxiety/Depression” dimension was the domain that contributed to lower losses in health state utility value. Conclusions. This study generated significant insight into the Brazilian population’s health preferences that can be applied to health technology assessment and economic analyses in Brazil. This information represents an important new tool that can be used in Brazilian health policy creation and evaluation.

A preference inversion occurs when "worse" health (instead of "better" health) along a scale or score is preferred. Our aim was to confirm past findings of EQ-5D-5L preference inversions among English-speaking respondents and to explore inversions among Portuguese-speaking respondents. Anecdotal evidence suggests that inversions may be more common in the Portuguese version, where the translation of the fourth level "severely" (gravemente) means "gravely."Through an infusion clinic in Tampa, Florida, United States and a cardiology clinic in Rio de Janeiro, Brazil, 740 respondents completed a tablet-based survey, which included the EQ-5D-3L and -5L followed by paired comparisons designed to assess preference inversions between the fourth and fifth levels of each of the five domains: Mobility (MO), Self-Care (SC), Usual Activity (UA), Pain/Discomfort (PD), and Anxiety/Depression (AD). An example from the AD dimension would be: "Which do you prefer? Starting today, 30 days with health problems: Severely anxious or depressed or Extremely anxious or depressed" (i.e., Level 4 AD vs. Level 5 AD).In the English-speaking respondents, preference inversion was only observed to a substantial extent in the AD dimension (U.S. N = 470; 7% MO, 14% SC, 14% UA, 20% PD, and 45% AD). Inversions were more common among the Portuguese-speaking respondents (Brazil N = 270; 11% MO, 32% SC, 35% UA, 49% PD, and 65% AD). Specifically, 44 out of 68 Brazilian respondents (65%) preferred "extremamente" (Level 5 AD) over "gravemente ansioso (a) ou deprimido (a)" (Level 4 AD).This evidence confirms previous findings for the U.S. English version of the EQ-5D-5L and led to a relabeling on the Portuguese version. It demonstrates the usefulness of collaboration between psychometric, econometric, and linguistic experts in developing the wording for and translating preference-based measures of health-related quality of life. Further research may explore inversions in other translations. The authors recommend that preference inversion tests should be included in the development and translation process.