A new health economic measure for improving the health and wellbeing of older Australians in subacute care settings: a study protocol

The measurement and valuation of quality of life for older people is critical for economic evaluation and for person-centred quality assessment across health and aged care sectors. However, most existing quality of life (QoL) measures were developed for younger populations and do not encapsulate what is important to older people’s QoL. The Quality of Life – Aged Care Consumers (QOL-ACC), a preference-based quality of life measure, co-designed with older Australians in aged care, addressed this gap and is now part of the National Aged Care Quality Indicator Program. Health and aged care systems for older people overlap as many individuals require a continuum of care that spans both sectors. In Australia, the health care system is predominantly occupied by older people, with subacute services the fastest growing area. Subacute care is a specialised multi-disciplinary care that supports recovery and functional optimisation where the main goal is maximisation of QoL. Building on our previous work in aged care, this study will develop and validate a QoL measure tailored to older people receiving subacute services, supporting improved care and informed policy making decisions. This study consists of three stages. Qualitative interviews with older people in subacute care settings to assess the face validity and content validity of the QOL-ACC measure using a think-aloud approach. These findings will inform revisions to the QOL ACC, which will then be tested using an iterative interviewing process. The revised QOL-ACC measure will then be validated for older people in subacute settings through rigorous psychometric assessments. Finally, a preference-based scoring algorithm to enable the calculation of quality-adjusted life years (QALYs) will be developed. Quality improvements are needed across the health care system, particularly for older people, who may have complex health needs. However, their voices are often not heard, as no suitable preference-based QoL measure exists to monitor their QoL. This study will co-develop and validate the first preference-based QoL measure for older people in subacute settings, enabling the application of the QOL-ACC across both health and aged care systems leading to better informed decision-making and maximising QoL outcomes for older people.