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  • QualityMetric’s health surveys capture reliable and scientifically valid patient-reported health outcomes information. A last count the surveys have been administered more than 76 million times worldwide and have been adapted for use in 130 languages. Used successfully in more than 1,900 clinical trials and referenced in more than 14,000 peer-reviewed articles, these surveys are proven responsive in 66 disease conditions and have been accepted by the Food and Drug Administration as proof of benefit for improved functioning and other PRO concepts. To date, 35 drug label claims have been approved using our tools.
  • Our surveys are available in multiple modes including…To ensure that the surveys are accessible to as many individuals as possible. It is also possible to complete a paper survey and scan it through a fax machine to collect and score the data automatically.
  • Mark:
  • The SF Health Surveys are the…Most reliable, rigorously validated, and widely used patient-reported outcome measures in the worldStandardized so that outcomes are comparable across groups, times, and populations
  • Here is a list of the disease-specific health surveys we offer. By the way this is a copy of the Asthma Control Test in Bulgarian!These are just a few of the surveys we have developed for clients over the years to measure disease impact, symptom control, health burden and risk. Things that can not be traditionally or medically measured.
  • Mark:

Health IT & Voice of Patient Health IT & Voice of Patient Presentation Transcript

  • Health IT and the Voice of the PatientUsing Cloud-Based Technology and Patient Reported Outcomes to Understand Population Health April 18, 2012
  • AgendaI. Company OverviewII. Smart Measurement SystemIII. Monitoring Population HealthIV. Case Study: Alberta Health Services Proprietary and Confidential. Do not distribute. 2
  • Existing Healthcare “System” Governments HospitalsWellness & Care PhysiciansManagment What’s Missing?Otherhealthcare Medical Deviceprofessionals companies Pharmaceutical & Biotechnology
  • The Patient!
  • I. COMPANY OVERVIEW Proprietary and Confidential. Do not distribute. 5
  • Company Overview• QualityMetric offers health Providers surveys that capture the (1,753) patient’s own assessment of their health• QualityMetric has grown Researchers (1,835) by 765% in the last 10 Payers (265) years• QualityMetric’s footprint spans the entire health care ecosystem Government Life Sciences (223) (1,044) Our Market Segments and Clients Proprietary and Confidential. Do not distribute. 6
  • Our Numbers 76,000,000 Survey administrations >21,000 License requests >18,000 Peer-reviewed articles 2,400 Published RCTs 140+ Language translations 35 Label claims Proprietary and Confidential. Do not distribute. 7
  • QualityMetric’s Culturally Appropriate Language Translations• QM has 11 Arabic language translations of our survey instruments (Egyptian, Saudi Arabian, Algerian, Jordanian, Lebanese, Moroccan, Palestinian, Qatari, Tunisian, and UAE)• QM has language translations for Indian (Bengali, Gujarati, Hindi, Kannada, Malayalam, Marathi, Odia, Punjabi, Tamil, Telugu, and Urdu), Pakistani (Urdu), and Filipino (Cebuano, Ilocano, Ilonggo, and Tagalog) Proprietary and Confidential. Do not distribute. 8
  • V. SMART MEASUREMENT SYSTEM Proprietary and Confidential. Do not distribute. 9
  • Smart Measurement™ System Outcomes in a Cloud Modes of Administration Phone | Online | Paper/Fax | Tablet | Smart Phone Patient Reminders & Data Provider Alerts Warehouse Scoring Engine Data feeds | Real Phone | Email | Post time | Batch Comparative Data Assets Management Customized Patient Report Provider Report Reports Analysis Proprietary and Confidential. Do not distribute. 10
  • Smart Measurement Components Content Scoring Reports Interfaces • eForms • ASP scoring • Member • Auto register • HTML web engine • Provider members form • API – vendor • Aggregate •Automated • Fax/OCR integration • Management result feeds • IVRS • Web • Custom (HL7, CDISC) • Web Smart services dash-boards •Patient Phone (SaaS) reminder (coming) • Desktop •Professional • Custom Alerts Proprietary and Confidential. Do not distribute. 11
  • IT Capabilities• Off-site hosted environment • Group, site, and individual • Look and feel to match host (24/7/365) U.S. and Canada role based access site• 128 bit secure socket layer • Ease of access through • Survey domains/items and (HTTPS) “single sign on” scoring• System complies with • Available from standard • Report modifications to HIPAA security and FDA Internet browsers meet your needs 21CFR part 11 privacy • HL7, CDISC formats to • Customized push/pull regulations standard EMR/EHR interfaces systemsSecurity Access Customization
  • Real-time Measurement and Reporting Computer (Desktop, Web) Fax (Paper OCR recognition) Phone (IVR) Tablet/Kiosk Proprietary and Confidential. Do not distribute. 13
  • The SF-12v2 Health Survey – iPhone App Version 14
  • The Asthma Control Test – iPhone App Version 15
  • Health Risk Assessment – iPad Version Proprietary and Confidential. Do not distribute. 16
  • II. MONITORING POPULATION HEALTH Proprietary and Confidential. Do not distribute. 17
  • Monitoring Population Health Risk Cost Benefit Prediction Analysis Disease Program Burden Evaluation Screening/ Population Health Stratification Health Registries Proprietary and Confidential. Do not distribute. 18
  • What is Population Health?• Taking stock of your population’s health status• Monitoring trends over time• Evaluating differences among subgroups• Noting variations in risk among these groups Proprietary and Confidential. Do not distribute. 19
  • Screening and Stratification • Identify patients for treatment • Determine score “cut points” for physical functioning and mental well-being • SF surveys are especially helpful for mental health Proprietary and Confidential. Do not distribute. 20
  • Disease Burden Assessment• Disease-specific benchmarks available for more than 30 different conditions• Ability to compare your population’s burden against what would be expected of the disease Proprietary and Confidential. Do not distribute. 21
  • Risk Prediction/Management • SF surveys are able to define risk by – Predicting increased use of MH Services – Predicting job loss due to health – Predicting depression diagnosis – Predicting Hospitalization – Estimating future medical expenses Proprietary and Confidential. Do not distribute. 22
  • Cost/benefit Analysis• SF surveys can be used for economic analysis (cost-benefit, cost- effectiveness, ROI)• Using a preference- based utility index (SF- 6D) QALY estimates can help assesses the economic benefit of various health care interventions Proprietary and Confidential. Do not distribute. 23
  • Program Evaluation • SF surveys can be used to develop benchmarks allowing the development of best practices • Identifying providers handling the greatest health risk • Allow the comparison of individual practitioners Proprietary and Confidential. Do not distribute. 24
  • IV. CASE STUDY: ALBERTA HEALTH SERVICES Proprietary and Confidential. Do not distribute. 25
  • AHS Case Study  Alberta Health Services (AHS) is the provincial health authority in AlbertaClient Canada  Responsible for delivering health care services to 3.5 million people  To implement a population health initiative that would monitor health outcomes in patients enrolled in community-based diabetes and obesity management and education programsChallenge  To generate geographically specific norms for the Edmonton area so that future outcomes measurement programs might benefit  To measure the impact of these programs in the community  Patients participating in both programs complete baseline surveys either in their doctor’s office or at the beginning of the educational classes with follow up suveys administered at six months and one yearSolution  To evaluate health outcomes scores were compared at baseline and one year  Results from both the diabetes program and obesity program offered information that helped AHS either improve the existing program or demonstrate its positive impact on patients Proprietary and Confidential. Do not distribute. 26
  • AHS Diabetes Program Outcomes Baseline One year Best 60 60Health 55 Norm 55 Norm 50 50 45 45 40 40 35 35 30 30Worse 25 25Health 20 20 N=130 Proprietary and Confidential. Do not distribute. 27
  • AHS Obesity Program Outcomes Baseline One year Best 60 60Health 55 Norm 55 Norm 50 50 45 45 40 40 35 35 30 30Worse 25 25Health 20 20 N=113 Proprietary and Confidential. Do not distribute. 28
  • Questions?Contact informationGus Gardner, President and Mark Bean, Vice President GlobalCOO, QualityMetric Incorporated Initiatives, QualityMetric Incorporated(401) 642-9239 (401) 585-6174ggardner@qualitymetric.com mbean@qualitymetric.com Proprietary and Confidential. Do not distribute. 29
  • III. MEASURING HEALTH Proprietary and Confidential. Do not distribute. 30
  • Three Seminal Studies• The Health Insurance Experiment (1974-1981) – First extensive use of psychometrics in health status surveys – Led by John E. Ware Jr. et al while at the RAND Corporation – Demonstrated self-administered surveys to be reliable and valid• The Medical Outcomes Study (1986-1990) – Four-year longitudinal, observational study of practice style variations for over 23,000 chronically ill patients – Led by Dr. Ware et al at the University of Chicago, RAND, and Tufts-New England Medical Center – Surveys measured 40 health concepts and became the basis for the SF- 36 Health Survey, which represented the eight most important concepts• The Medicare Health Outcomes Study (1998-2004) – The 1997 Balance Budget Act directed Medicare to focus on the health status of beneficiaries – CMS worked with NCQA to incorporate Medicare beneficiaries into HEDIS and expand outcomes measures – The SF-36 Health Survey was recommended as a core measure in an annual assessment of physical and mental health 31
  • The SF Health Surveys Most reliable, rigorously validated, and widely used patient-reported outcome measures in the world Standardized so that outcomes are comparable across groups, times, and populations Used during all phases of drug/biologic/device development Eight health domains measured Physical Health Mental Health Summarized as physical health scores and mental health scores Benchmarked against a norm, or T- score, of 50, which is age and gender specific Proprietary and Confidential. Do not distribute. 32
  • Disease-specific Health Surveys• Asthma Control Test (ACT)• MOS Sleep Scale• Pain Impact Questionnaire (PIQ-6)• Headache Impact Test (HIT-6)• Rhinitis Impact Survey• PMSIS Impact Survey• Asthma Impact Survey (AIS-6)• MOS Cognitive Functioning Scale Proprietary and Confidential. Do not distribute. 33
  • SF Bibliography Total Articles 17,038 16,585 16,001 14,072 12,828 12,088 11,081 11,461 10,240 8,6809,250 7,2507,7168,130 6,502 5,595 4,791 4,0654,275 2,3901,441 Jan-10 Jan-02 Jan-03 Jan-04 Jan-05 Jan-06 Jan-07 Jan-08 Jan-09 Jan-11Jul-01 Jul-02 Jul-03 Jul-04 Jul-05 Jul-06 Jul-07 Jul-08 Jul-09 Jul-10 Jul-11 Updated 7/2011 Proprietary and Confidential. Do not distribute. 34
  • A Universal Measure of Health • 50% reduction in physical disability • 33% reduction in hospitalization • Substantial increase in work productivity • Reduced expenditures Asthma Asthma Before After Congestive Heart Rx Rx Failure Chronic Lung Diabetes Disease Average Average Type II Adult Well Adult Treatment 30 40 50 Physical Component Summary (PCS) Proprietary and Confidential. Do not distribute. 35
  • What We Do – The Predictive Power of SF Tools* SF-12 MCS Scores Predict SF-12 PCS Scores Predict Future Use of MH Services Hospitalization within 6 months 35% 75% 62% 26% 54% 19% 36% 16% 26% 8% 10% 14% 16% 6% 3% 5% 0% 2%60-65 55-60 50-55 45-50 40-45 35-40 30-35 25-30 20-25 60-65 55-60 50-55 45-50 40-45 35-40 30-35 25-30 20-25 SF-12 MCS Scores Predict SF-36 PCS Scores Predict Job Depression Diagnosis Loss Due to Health 60% 32% 51% 42% 18% 35% 24% 10% 8% 10% 3% 1% 2% 55-65 45-55 30-40 15-25 60-65 55-60 50-55 45-50 40-45 35-40 30-35 25-30 20-2536 * X axis is a range of PCS or MCS scores
  • What We Measure What is Your Health? Social & Role • Bodily structure and Physical & Mental function • What you are able to do: functioning Biologic Function • How you feel: distress and well-being Function & • What you say it is: Well-being personal evaluation Participation Sources: WHO, ICIDH-2, 2001 (www.who.org) Proprietary and Confidential. Do not distribute. 37
  • Quality of life Community Marriage Education Nation Family Life Neighborhood Friendships Self Health Standard of Living Housing Work Source: Campbell 1981 Proprietary and Confidential. Do not distribute. 38
  • What is your health? • Bodily structure and function • What you are able to do: functioning • How you feel: distress and well-being • What you say it is: personal evaluation Best captured using patient-reported outcome (PRO) tools Sources: WHO, ICIDH-2, 2001 (www.who.org) Proprietary and Confidential. Do not distribute. 39
  • Eight Health Domains Perform normal physical activities Physical Function Feelings of Mental Role- Interference with peace, happiness, Health physical work resulting from nervousness, or physical problems depression SF Level of pain Interference with Role- Bodily work resulting from emotional Health Pain impacting Surveys normal activities emotional problems Limited social Social General Perspective on activities due to Function Health and expectations physical or emotional for health problems Vitality Level of energy or tiredness Proprietary and Confidential. Do not distribute. 40
  • SF Bibliography (by Condition) Allergic Rhinitis 104 ALS 41 Angina 197 Arthritis-General 858 Arthritis-Juvenile Idopathic 59 Arthritis-Osteo. 589 Arthritis-Rheum. 451 Asthma - Adult 417 Asthma - Pediatric 109 Cancer 1336 Cardiovascular 275 Caregiver Studies 275 Carpal Tunnel 33 Chronic Fatigue 289 COPD 307 Cystic Fibrosis 34 Dementia 73 Dental 128 Depression 2420 Dermatology 358 Diabetes 787 Eating Disorders 44 Emphysema 33 ENT 158 Endocrinological (not Diabetes) 93 Epilepsy 94 Eye Impairment 145 Fibromyalgia 208 Gastrointestinal 355 Headache/Migraine 383 Hepatitis 373 HIV/AIDS 412 Hypertension 373 IBS/IBD 172 Updated 7/2011 Proprietary and Confidential. Do not distribute. 41
  • SF Bibliography (by Condition) Liver 109 Low Back Pain (Sciatica) 416 Lupus 178 Lyme Disease 13 Mental Health 4872 MS 238 Musculoskeletal 2322 Neuromuscular 122 Obesity 665 Osteoporosis 107 Pain 938 Parkinsons Disease 113 Psychiatric 5102 Pulmonary (not Cardio) 501 Renal/Kidney 501 Senior Studies 1081 Sexually Transmitted Disease 114 Sleep Disorders 208 Spinal Injury 124 Stroke 361 Substance Abuse 417 Surgical 3086 Transplantation 483 Trauma 586 Urinary Incontinence 173 Vascular (not Pulmonary) 695 Vascular (Pulmonary) 96 Womens Health Issues 1759 Work-Related 1003 Other Diseases 434 Updated 7/2011 Proprietary and Confidential. Do not distribute. 42
  • Identifying the “Flat of the Curve” • More is not always better • There is a point where more care no longer improves health • PROs can help you Increased Benefit find that point Waste Increased Cost Proprietary and Confidential. Do not distribute. 43
  • More Results from the AHS Project (Obesity Program) Physical Health Outcomes Mental Health Outcomes64% 49% 37% 37% 35% 35% 32% 24% 27% 23% 23% 22% 20% 15% 14% 15% 14% 15% 15% 10% 13%12% 7% 9%Limted in activities Accomplished Limited in work Reporting pain Limted in social Worked less Not calm/peaceful Downhearted/ less activities carefully depressed Baseline One Year Norm Baseline One Year Norm Proprietary and Confidential. Do not distribute. 44
  • Quotes from the AHS Population Health Study “It’s useful to see how my health “79% of Edmonton’s compares to my peers – other diabetics and obese people. population has one or Seeing my scores is liberating more chronic conditions because now I know if I’m more or and 40% have more less healthy than other people than three.” who have similar health -Health Quality of Life concerns.” Measurement Tool Final Report, July 2010 -A patient involved in the AHS project “Physicians and patients reported that the survey provided a quick assessment of mental and physical health which had clinical value. If the patient’s mental or physical health scores were less than optimal, patients and providers reported discussing contributing factors to the decline.” -Health Quality of Life Measurement Tool Final Report, July 2010 Proprietary and Confidential. Do not distribute. 45
  • What’s Next at AHS• Expanding the program from a focus on initial studies and two cohort groups (obesity and diabetes) to enrolling entire populations• Currently over 1/3 of Alberta’s Primary Care Networks are using SF- 12v2 and Smart Measurement System to monitor their population’s health• Alberta Primary Care Networks are obtaining patient measurement and real time reporting that is tailored for their specific needs• This is Health IT in action Proprietary and Confidential. Do not distribute. 46