ASCOT (Adult Social Care Outcomes Toolkit) preference-weighted measure
ASCOT is a method used to measure how adult social care services affect people's quality of life. It works like the QALY used in health care but focuses on social care. It looks at eight areas of life such as dignity, safety, and control over daily life, and compares a person's current quality of life with what it would be without care services. This difference shows the impact of the services.
At a glance
Use when
Evaluating the effectiveness and cost-effectiveness of adult social care interventions; conducting economic evaluations in social care; measuring quality of life impacts beyond health outcomes.
Avoid when
Assessing outcomes for informal caregivers; when integration with health QALYs is required without additional mapping; in populations unable to complete self-reported SCRQoL assessments.
Inputs
Responses to the ASCOT instrument on current and expected SCRQoL across eight domains, preference weights derived from BWS/TTO studies.
Outputs
Preference-weighted SCRQoL scores, SCRQoL gain (difference between current and expected), social care QALY-like metric for use in economic evaluations.
How it works
The ASCOT preference-weighted measure is a multi-attribute instrument assessing social care-related quality of life (SCRQoL) across eight domains: personal cleanliness and comfort, accommodation cleanliness and comfort, food and drink, safety, social participation and involvement, occupation, control over daily life, and dignity. It incorporates both current and 'expected' SCRQoL (i.e., anticipated state without services) to estimate service impact. Preference weights were derived using best-worst scaling (BWS) with 1000 members of the general population, supported by discrete choice experiments (DCE) and computer-aided time trade-off (TTO) studies. A formula links BWS and TTO values to generate a social care QALY metric, anchored at 0 ('dead') and 1 ('ideal' SCRQoL). The measure has demonstrated validity, reliability, and consistency across populations.
- HTA domains
- Patient and Social Aspects
- Categories
- HRQoL
- Assumptions
- Preferences of the general population can inform social care valuation; SCRQoL can be meaningfully described in eight domains; individuals can reliably assess their 'expected' state without care; trade-offs between domains are valid and measurable.
- Strengths
- First application of TTO in social care context,Uses robust preference elicitation methods (BWS, DCE, TTO),Validated with large samples of both service users and general population,Enables economic evaluation of social care similar to QALY-based methods in health,Captures service impact through expected vs. current SCRQoL comparison
- Limitations
- Further development needed for informal carers,Limited integration with health QALYs,General population weights may not fully reflect service user values,Cognitive burden of preference elicitation methods
- Also known as
- ASCOT, Adult Social Care Outcomes Toolkit, ASCOT preference-weighted measure, social care QALY
Questions this answers
- › What is the impact of social care services on service users' quality of life?
- › How does an individual's current social care-related quality of life compare to what it would be without services?
- › Which aspects of social care most influence quality of life from a public perspective?
- › Can quality of life gains from social care be quantified similarly to health gains (e.g., QALYs)?
- › Are public preferences aligned with those of social care service users?
- › How can social care outcomes be valued for economic evaluation?
References & sources
Similar by meaning
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