„International Research Project on Financing Quality in Health Care”

InterQualityWP 2

Values/Benefits (development of methodology for cost and outcome of care measurement)

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

• 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 2.1.common terminology and conceptual framework for costs and

outcomes measurement and methods of measuring costs

Need to develop standard definitionsSend request to partners for 5-10 main relevant terms for

development of definitionsIterative process of developing and refining definitionsDefine terms that are relevant across all of the health care

systems that are involvedCompare whether terms mean the same thing in different

systems (for example, “integrated care”)Other work packages begin in month 7, so definitions are priority

General Literature Review Methods

PubMed, EMBASE, CochraneMESH term searches very broad – several thousand resultsCriteria to exclude articles – consider narrowing to last 10

years, or narrowing to participating countriesStart with secondary sources – OECD, Cochrane, WHO,

Cochrane, AHRQStandard international guidelines for HTA evaluationsSolicit suggestions or input from other task leaders about

highest priority areas for literature reviewCooperate with partners to prepare templates to describe the

information that is needed from the papers that are reviewed

Issues related to specific literature reviewsMethods of measuring costs Methods of evaluating economic efficiency- EUnetHTA- HTA bodies within participating countries (e.g., AHRQ)Methods of measuring quality of healthcare (also equity)- OECD Health Care Quality Indicators project- Health consumer powerhouse (Swedish) – questionnaires evaluating

patients’ experiences with care (diabetes, CV)- European Union (EUPasnet) and EC organizations- FP7 and FP6 grant recipients (for example, ECHO)- AHRQ National Healthcare Quality Report, National Healthcare

Disparities Report- WHO- AHRQ National Quality Measures Clearinghouse – 1300+ measures- National Quality Forum – qualityforum.org 600+ measures

How to prioritize measures of quality and equity

• Measures that cut across multiple clinical domains• Measures that can be implemented across multiple

participating countries• High-impact measures that address overall quality of

health care system• “Running document” that can capture new ideas as

they arise, and respond to new concerns and problems (use website, blog)

• Questionnaires filled in by patients? (CAHPS)

Task 2.2.Input from collaborative partners

• Partners will provide WP leader with results of review of literature perceived as relevant to country specific health care system issues– Input into search strategy– In some cases, different WPs may implement different search strategies to

address the same topic in collaboration – Establish mechanism for collaboration on literature reviews that involve

multiple WPs

• Input from collaborative partners (15Man-Month) from 3 to 5 Months of the Project: UI (2), MHH, UY, SDU, SPH, UniCT, CPME, EPF

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 – Indicators that can be used across multiple financing systems to permit

inferences regarding impact of changes and differences– Need administrative procedure for obtaining and assimilating input from

other WPs• Country-specific considerations that make particular cost and

outcomes of care measurement approaches desirable or particularly problematic will be identified – For example, correlation between patient satisfaction and level of

spending on health services– Identify indicators that are particularly helpful as markers of quality of

health care system, and may be sensitive to payment changes– Build on WHO work

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– Best practices (guidelines) for statistical analytic methods– What issues need to be taken into consideration?– Buy/recommend statistical packages or open source tools– Need clear question or set of questions from other WPs

• 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– Will be implemented locally at MUW, accessible to all partners– Encourage more data to be available for research in Poland

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