Designing acceptable services to better serve lower-acuity presenters to emergency departments: A latent class analysis of a discrete choice experiment in Australia

Objectives Presentations to ED are growing, worsening pressure on the health system. A discrete choice experiment (DCE) was undertaken to determine the factors that influence why patients choose the ED over primary care for low-acuity presentations. Methods A DCE was carried out at two tertiary hospital EDs between October 2022 and February 2023 in adult patients with lower triage scores. Attributes included waiting time, cost, facility, care type and provider. Participant preferences were estimated using mixed multinomial logit (MMNL) and latent class models. Willingness to pay and policy simulations were also carried out. Results 281 participants were recruited. The MMNL model revealed that patients preferred care with 30 min waiting times (β=0.75, 95% CI 0.59 to 0.91), no out-of-pocket payments (β=1.18, 95% CI 0.97 to 1.39), in-person delivery (β=0.62, 95% CI 0.51 to 0.73) and the availability of on-site investigations (β=0.83, 95% CI 0.68 to 0.98). A latent class analysis revealed three distinct cohorts of patients: those who would choose the ED regardless of other options (26% of the sample), those swayed largely by cost (29%) and those who would go elsewhere if another option was offered (45%). Conclusion The study showed patient preferences for various health service options and the strength of those preferences. A latent class analysis showed distinct subgroups within this cohort, each likely to respond differently to various policy scenarios and health service options. There was heterogeneity within the responses, which should be a target for policy. This information could be used to design services that more adequately meet patient preferences.