„International Research Project
on Financing Quality in Health Care”
InterQuality
WP 2
Values/Benefits (development of methodology
for cost and outcome of care measurement)
„International Research Project
on Financing Quality in Health Care”
Joanna Lis
Tomasz Hermanowski
Warsaw Medical University
WP2: Objectives
• To solve methodological challenges raised by
analysis of patient-level data in international
comparative research
• All Consortium partners will contribute with input
on data availability and particular challenges in
their countries
• 9 months
– from 3 to 12 months of the Project
– 1 March 2011 – 31 Nov 2011
3
4
5
6
7
8
9
10
11
12
WP2: Objectives
• Main objectives are to develop consensus and guidelines on:
– common terminology and conceptual framework for costs and
outcomes measurement and methods of measuring costs (task 2.1)
– methods of evaluating economic efficiency, based on NICE
guidelines for health technology evaluation and IQWIG efficiency
frontier, including guidelines for measuring patient-relevant
outcomes (PRO) (task 2.2)
– methods of measuring quality and equity of healthcare (task 2.3)
– methods of statistical analysis across countries, differentiating
between country and policy effects (task 2.4)
Task 2.1.
common terminology and conceptual framework for costs and
outcomes measurement and methods of measuring costs
• Literature and methodology review, definition development:
–
–
–
–
–
Methods of outcomes& costs measurements
Methods of evaluating economic efficiency
Methods of measuring quality of healthcare
Methods of measuring equity of healthcare
Methods of statistical analyses/methods across countries,
differentiating between country and policy effects
Task 2.1.
common terminology and conceptual framework for costs and
outcomes measurement and methods of measuring costs
• In order to avoid misunderstandings definitions of terms and
conceptual framework of contemplated research will be
agreed by all Consortium partners
• The task will start with a review of basic reference sources, like
ISPOR Book of Terms
• (10 Man-Months) from 3 to 5 Months of the Project
• Input from MUW (38Man-Month)s from 3 to 5 Month of the
Project
Task 2.2.
methods of evaluating economic efficiency, measuring patientrelevant outcomes, costs, quality & equity in health care
• Literature (and other available sources) review covering a range
of fields:
– Measuring costs
– Economic evaluation (outcomes&costs)
– Measuring quality
– Measuring equity
in areas of pharmaceutical care, hospital care, outpatient care
and integrated care.
Task 2.2.
methods of evaluating economic efficiency, measuring patientrelevant outcomes, costs, quality & equity in health care
• Measuring costs in healthcare systems
– Methods of measuring costs will be described
• Direct
• Indirect
– Availability of costs data will be analyzed by all
Consortium Partners
• Impact different healthcare systems organization on
measuring costs
Task 2.2.
methods of evaluating economic efficiency, measuring patientrelevant outcomes, costs, quality & equity in health care
• Economic evaluation (outcomes&costs) efficiency
– Identification and description of efficency indicators
– Methods of measuring patient-relevant outcomes will
be reviewed (PRO)
– Based on comparative analysis of existing methods of
health technology evaluation guidelines for empirical
analysis of cost efficiency will be developed
Task 2.2.
methods of evaluating economic efficiency, measuring patientrelevant outcomes, costs, quality & equity in healthcare
• Measuring quality
– Systematic review of publications will be performed
• Scales and questionnaires
– Generic
» Health Profile
» Utility Measurements
– Specific
– Results and databases, created in the framework of
previous research projects, financed by FP 6 and 7,
will be reviewed
– Recommended methods for comparative analysis of
healthcare quality will be proposed
Task 2.2.
methods of evaluating economic efficiency, measuring patientrelevant outcomes, costs, quality & equity in healthcare
• Measuring equity:
– Results of up-to-date research projects, financed
by EU, OECD, WHO and World Bank by FP 6 and 7,
will be completed
– State-of-the art analytical methods will be used to
evaluate equity of access to sectors of care and
countries, up to now not analyzed
Task 2.2.
methods of evaluating economic efficiency, measuring patientrelevant outcomes, costs, quality & equity in healthcare
• Partners will provide WP leader with results of review of literature
perceived as relevant to country specific health care system issues
• Input from collaborative partners (15Man-Month) from 3 to 5
Months of the Project:
UI (2), MHH, UY, SDU, SPH, UniCT, CPME, EPF
Input from collaborative partners
1.
Consortium partners will be asked to execute, in the framework of
collaborative work, systematic reviews of publications & other available
sources for:
–
measuring of costs &outcomes, cost efficiency, quality and equity in healcare
system (inpatient &oupatient care, integrated care and pharmaceutical care
etc)
–
UI (2 Man-Months) at the end of two months of the project, WP1 Leader will
be asked to provide protocol and preliminary results of literature review and
catalogue of criteria related to costs, cost efficiency, quality and equity
(deadline – end of 2 Project Months).
2.
The objectives are:
–
Identify and execute a comprehensive review of all indicators / measures of
quality used in healthcare systems worldwide and used in countries of
collaborative partners
–
Compare impact of indicators / measures on the quality of healthcare system
Task 2.2.
Input from collaborative partners (15Man-Months)
from 3 to 5 Month of the Project:
Work package No
Work package title
Activity type
Participant No
Participant short name
Person-month per participant
2
Start date of starting event
3
Values/Benefits (development of methodology for cost and outcome
of care measurement)
RTD
1
5
2
6
3
7
4
8
9
MUW
UI
MHH
UY
SDU
SPH
54
2
2
2
2
3
UniCT CPME EPF
2
1
1
Task 2.2.
Input from collaborative partners (15Man-Months)
from 3 to 5 Month of the Project: Issues for discussion
• Literature&other sources review:
– Define period of review (1990-2010)?
– Source od data: MEDLINE, EMBASE, Cochrane, Centre for Reviews and
Dissemination database, HEED, DARE, AHRQ, OECD, WHO … but also
• using literature references contained in clinical trial publications,
• searching data published in specialist journals in the field of
interests
– Searching procedure(2 analysts, abstracts vs full versions, etc)
• A common template for reporting the results of literature
searches and databases
Task 2.3.
Comparative analysis of value/benefits measurement
• A summary of the perceived strengths and weaknesses of
methodology for cost and outcomes of care measurement will be
developed
• Areas of both consensus and disagreement will be identified
• Country-specific considerations that make particular cost and
outcomes of care measurement approaches desirable or
particularly problematic will be identified
•
(10 Man-Months) from 6 to 8 Month of the Project
Task 2.4.
Methodology of statistical analysis across countries & Data Warehouse
• On the basis of multilevel statistical analysis methodology,
recommended methods for cross country comparative analysis
will be identified
• Adopted methods will enable Consortium Partners to identify
country and policy effects in different data sets
• In order to collect and analyze statistical data in uniform
format, dedicated Data Warehouse will be prepared and used
by all project participants
• (18 Man-Months) from 9 to 12 Month of the Project
WP2: Milestones
• Data Warehouse test version start-up:
– expected launch of data warehouse (test version) is after 10 Project
Months
• Methodology for Healthcare measurements development :
– all guidelines and reports shall be validated and accepted by General
Assembly in November 2011 (after 12 Project Months)
WP2: Deliverables
1. Catalogue of definitions related to quality, equity, outcomes
and costs evaluation as well as comparative value/benefit
analysis (Guidelines on comparative evaluation)
2. Data Warehouse with Guidelines on statistical analysis
across countries, differentiation between country and
policy effects in different data sets, taking into
consideration data availability and respecting
confidentially requirements
WP2: Deliverables
• Hybrid database, managed by program CMS,
which, in addition to reports of systematic
reviews will put a bibliography of sources,
with full description and possibly a short
summary or review, links to other databases,
descriptions of tools for measuring quality,
efficiency, equality of access, etc.
„International Research Project
on Financing Quality in Health Care”
joanna@fraktal.com.pl
= 48 607 370 093
BACK-UPS
Outcomes
 Natural measurements :
 E.g In oncology: OS, TTP, PFS …
 QALY (quality adjusted life year)
 HYE – (healthy year equivalent)
 SAVE – (saved young life equivalent)
 DALY - (disability-adjusted life years)
…
Costs


Direct Medical
 Resources spent on medical services or products as a direct consequence of a disease or illness
 Resources directly consumed to produce a given outcome or consequence
Direct Nonmedical
 Expenses related to the provision of medical care, but incurred outside the medical sector
 Transportation to a medical care facility
 Childcare
 Lodging
•
Indirect Costs:
– Amounts spent or lost as an indirect consequence of illness or consumption of
medical care
• Lost wages due to sickness
• Lost production
• Premature death?
•
Intangible Costs
– Pain and suffering
– Social and emotional stress
Utility
QALY
Health
1
Utility
Therapy B
Therapy A
No treatment
Death 0
Death with
treatment A
Death with no
treatment
time
Death with
treatment A
Influences on quality of life (QoL)
Disease
Treatment
Impairments
(symptoms)
Disability
(functioning)
HRQL
Demographics
Personality
QoL
Culture /
economy
Social
Environment
Stephen McKenna
Galen Research, Manchester, UK
Types of patient-reported outcomes
Impairment (well-being)
=
Disability (functioning)
Handicap (participation)
Health-related
quality of life
(HRQL)/
(Health status)
QoL
HRQL ≠ QoL
Rather than being HRQL or health status.. “QoL is a reflection of the way in which patients perceive and react to their
health status and to other non-medical aspects of their lives.”
Equity
• Equity in health can defined
as the absence of socially
unjust or unfair health
disparities.
• However, because social
justice and fairness can be
interpreted differently by
different people in different
settings
EQUITY in health can be defined as the
absence of disparities in health (and
in its key social determinants) that
are systematically associated with
social advantage/disadvantage.
Health inequities systematically put
populations who are already socially
disadvantaged (for example, by
virtue of being poor, female, or
members of a disenfranchised racial,
ethnic, or religious group) at further
disadvantage with respect to their
health.