Assessment of assistive technology : outcomes, costs and quality

Sammanfattning: Technology assessment aims at providing information about costs and effects, in order to support decision making and resource allocation. The purpose of this thesis is to, through empirical studies on assistive technologies, investigate the contribution of various kinds of outcome measures, and provide knowledge about outcomes, costs and quality of services.Welfare losses were found for disability groups compared to the general population. High health care utilization and needs for a better social life was also expressed by disabled people in the study.For stroke patients assistive devices amounted to about 1.3 per cent of the total costs for health care and services during the first year after stroke. Functional ability by admission to hospital was found to be an important predictor of the total cost. Those with assistive devices, although having achieved a high functional ability one year after the stroke, perceived and rated their life situation considerably more impaired than those without assistive devices. It was found that utilizers of assistive devices had low influence on the selection process.A new program, based on improved user participation, for the selection process of assistive devices was found to yield increased user participation, user satisfaction, increased number of devices, and consequently also higher costs for assistive technology. The outcome measures, indicating functional ability and health related quality of life, showed more vague improvements. Women below 64 years rated improved health related quality of life at a follow-up. No improvement in functional ability was found at this follow-up.An assessment of computer aided assistive technologies was performed. It was found that the average goal fulfilment was high regarding handling the equipment, functional ability, and activities and roles. No significant changes were found in health related quality of life and utility for the clients. However, clients with speech impairment rated impaired utility at the follow-up, and clients with other communication disabilities rated an improved utility. The average total cost per person (including selection process and device) amounted to SEK 14 800.Measures on process and outcome can yield complementary results, and thus, they are important in order to understand the relations between quality of services and outcomes. Outcome measures are usually developed for the health care sector, and have the purpose to reflect the impact of health changes. This is a problem in assessments of assistive technology, since health, and disability or handicap, are not always closely related. The distinction between disability and handicap, as defined by the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) by WHO 1980, is usually not reflected in outcome measures available.