Abstract
BackgroundThe Adult Social Care Outcomes Toolkit (ASCOT-SCT4) is a multi-attribute utility index designed for the evaluation of long-term social care services. The measure comprises eight attributes that capture aspects of social care-related quality of life. The instrument has previously been validated with a sample of older adults who used home care services in England. This paper aims to demonstrate the instrument’s test-retest reliability and provide evidence for its validity in a diverse sample of adults who use publicly-funded, community-based social care in England.MethodsA survey of 770 social care service users was conducted in England. A subsample of 100 services users participated in a follow-up interview between 7 and 21 days after baseline. Spearman rank correlation coefficients between the ASCOT-SCT4 index score and the EQ-5D-3 L, the ICECAP-A or ICECAP-O and overall quality of life were used to assess convergent validity. Data on variables hypothesised to be related to the ASCOT-SCT4 index score, as well as rating of individual attributes, were also collected. Hypothesised relationships were tested using one-way ANOVA or Fisher’s exact test. Test-retest reliability was assessed using the intra-class correlation coefficient for the ASCOT-SCT4 index score at baseline and follow-up.ResultsThere were moderate to strong correlations between the ASCOT-SCT4 index and EQ-5D-3 L, the ICECAP-A or ICECAP-O, and overall quality of life (all correlations ≥ 0.3). The construct validity was further supported by statistically significant hypothesised relationships between the ASCOT-SCT4 index and individual characteristics in univariate and multivariate analysis. There was also further evidence for the construct validity for the revised Food and drink and Dignity items. The test-retest reliability was considered to be good (ICC = 0.783; 95% CI: 0.678–0.857).ConclusionsThe ASCOT-SCT4 index has good test-retest reliability for adults with physical or sensory disabilities who use social care services. The index score and the attributes appear to be valid for adults receiving social care for support reasons connected to underlying mental health problems, and physical or sensory disabilities. Further reliability testing with a wider sample of social care users is warranted, as is further exploration of the relationship between the ASCOT-SCT4, ICECAP-A/O and EQ-5D-3 L indices.
Highlights
The Adult Social Care Outcomes Toolkit (ASCOT-Four-level self-completion questionnaire (SCT4)) is a multi-attribute utility index designed for the evaluation of long-term social care services
The Adult Social Care Outcomes Toolkit (ASCOT) is a suite of instruments designed to capture social care-related quality of life (SCRQoL), which is defined as aspects of quality of life that are important to social care service users and may be compensated for by social care support [9]
Local authority (LA) adult social services departments and home care providers identified the sample from social care records based on the following eligibility criteria: aged 18 years or over, in receipt of fully or partly publiclyfunded community-based social care services, not in residential or nursing care, and primary support reason recorded as physical disability or sensory impairment (PDSI) or mental health condition (MH) or learning disability (LD)
Summary
The Adult Social Care Outcomes Toolkit (ASCOT-SCT4) is a multi-attribute utility index designed for the evaluation of long-term social care services. Social care systems across Europe vary in their balance of informal or unpaid care and formal care provided by social care services; ageing populations are projected to increase overall demand for formal care in Europe over the few decades [1] In this context, and alongside a reduction in public spending on social care in some European countries [2], there is heightened interest in how to evaluate the (cost-)effectiveness of social care services to make the best use of resources. The Adult Social Care Outcomes Toolkit (ASCOT) is a suite of instruments designed to capture social care-related quality of life (SCRQoL), which is defined as aspects of quality of life that are important to social care service users and may be compensated for by social care support [9]
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