Abstract

Objectives: The ASCOT-NL project aimed to develop a Dutch version of the Adult Social Care Outcomes Toolkit (ASCOT) that can be used to evaluate outcomes of care services provided to community-dwelling older adults in order to guide/assist (1) development of personal care plans (2) quality improvement and monitoring (3) allocation decisions / commissioning of care.

Methods: Step 1 – identification of potentially missing quality of life (QoL) domains in the original ASCOT for our target group. Semi-structured interviews with community-dwelling older adults were conducted to provide insight into their experiences with receiving care services and the influence of these services on their QoL. Through purposive sampling, respondents were recruited to participate in this study. A qualitative inductive approach was used. The topic guide was based on a theoretical framework consisting of domains identified in a systematic review of qualitative studies on aspects influencing QoL (autonomy; role and activity; health perception; relationships; attitude and adaptation; emotional comfort; spirituality; home and neighbourhood; financial security).

Step 2 – generating Dutch preference weights for the ASCOT. Using a combination of Best Worst Scaling and Time Trade Off techniques preferences will be estimated.

Results: Older adults indicate that medical care services contribute to their health in a broad sense. In addition, medical care services contribute to autonomy, role and activity, relationships, attitude and adaptation and emotional comfort. Social care services and support in daily living services also influence multiple quality of domains (relationships, role and activity, autonomy, home and neighbourhood, and financial security). Care services can also negatively impact quality of life, especially autonomy. Older adults dislike being dependent on others and not being able to make their own choices with regard to food or timing of care services.

Based on these results, six add-on domains were formulated to be included in an adapted version of the original ASCOT, that is the ASCOT-NL quality tool (objectives 1 and 2): accessibility and age-friendliness of your neighbourhood, connectedness, financial security, perceived health, resilience, and emotional comfort. In a small number of think-aloud interviews, community-dwelling older adults indicated that they understood the meaning of these add-on domains and that they considered them relevant for their quality of life.

Currently, we are estimating the preference weights for the ASCOT-NL including only the domains of the original ASCOT (objective 3). The results of these analyses will be presented during the conference.

Conclusions: For the ASCOT-NL quality tool, six additional domains of quality of life were identified in our project that were considered relevant by older adults. Which domains are included in the evaluation of care services will primarily be determined by the purpose of the evaluation and of these services. We expect that providing the relevant stakeholders in a specific setting (e.g. homecare) with a flexible and adaptive tool (ASCOT-NL quality tool) to measure quality of life of older adults facilitates valid assessment of the outcomes and quality of care services. In addition, the availability of Dutch preference weights will support policy makers in decisions on how to distribute available resources efficiently.