OHE hosted a Lunchtime Seminar that examined both the approach and the results of research to date. OHE's Koonal Shah presented his research, which was critiqued by Dr Rachel Baker of Glasgow Caledonian University. Both presentations are included in this file.
Effectiveness of CBT for anxiety disorders in mental health clinics and in schools as indicated prevent. Jon Bjåstad et al. Anxiety Disorders Research Network, Haukeland University Hospital, Norway
Ambulatory Mental Health Visits and Use of Psychotropic Medicines by Cancer S...HMO Research Network
The document examines the utilization of mental health services and medications among cancer survivors' spouses. It finds that younger spouses of cancer survivors use ambulatory mental health services and psychotropic medications at higher rates than spouses of non-cancer individuals. A cancer diagnosis within the past year significantly predicts higher utilization of mental health services. However, cancer diagnosis and factors are not significant predictors of prescribed psychotropic medication use. The study is limited by a lack of data on cancer stage and treatment, as well as spouses' prior mental health.
This document summarizes research on depression in early stage dementia and the development of an intervention called IDEA (Intervention to prevent Depressive symptoms and promote well-being in EArly stage dementia). It finds depression is common in dementia, with risks including age, agitation, and sleep disturbances. Existing treatments show little evidence but behavioral activation shows promise. IDEA aims to develop and test in an RCT a behavioral activation intervention for early stage dementia to prevent depression. It involves consulting people with dementia and carers to develop a treatment manual and will examine feasibility and acceptability.
This randomized controlled trial compared the effectiveness of cytisine to nicotine replacement therapy (NRT) for smoking cessation. The trial involved 1310 daily smokers who received either a 25-day course of cytisine plus behavioral support or 8 weeks of NRT plus behavioral support. The primary outcome was abstinence at 1 month, with secondary outcomes including abstinence at 2 months and 6 months. Results showed cytisine was at least as effective as NRT for smoking cessation, with abstinence rates of 40% for cytisine vs 31% for NRT at 1 month. Cytisine was also associated with longer time to relapse and fewer withdrawal symptoms compared to NRT. Adverse effects were more common but mostly
1) A clinical trial assessed whether chelation therapy improved quality of life outcomes in patients with stable coronary artery disease and a history of heart attack.
2) The trial found no consistent or sustained improvements in domains of health-related quality of life, including physical and mental functioning, with chelation therapy over 2 years of follow up.
3) A subgroup analysis found a potential benefit of chelation therapy for patients with angina symptoms at baseline, but no benefit was seen for patients with heart failure symptoms.
1. This study aimed to empower sub-district administration organizations (SDAOs) in Thailand to become health promoting organizations.
2. After implementing health promotion activities and training, SDAOM members had higher knowledge, attitudes, and enabling factors toward health promotion.
3. Many new health promotion activities emerged, health promotion plans and policies were established, and community participation increased.
Many suicidal patients do worry a lot about their reasons for contemplating suicide, about the meaning of life, about their failures, about their losses and disappointments, and they worry about their suicidal thoughts. Part of the suicidal urges are caused by the wish to stop this endless worrying and rumination. It is hypothesized that anti – worry exercises may help suicidal patients to decrease the amount of time a day that they are thinking of suicide, and therewith decrease the intensity of the reasons for contemplating suicides. In the workshop CBT techniques for worrying and rumination will be explained and applied to suicidal worrying. In the workshop participants are requested to present actual cases and engage in role playing, therewith train their skills in addressing persistent repetitive thoughts of suicide in patients.
Effectiveness of CBT for anxiety disorders in mental health clinics and in schools as indicated prevent. Jon Bjåstad et al. Anxiety Disorders Research Network, Haukeland University Hospital, Norway
Ambulatory Mental Health Visits and Use of Psychotropic Medicines by Cancer S...HMO Research Network
The document examines the utilization of mental health services and medications among cancer survivors' spouses. It finds that younger spouses of cancer survivors use ambulatory mental health services and psychotropic medications at higher rates than spouses of non-cancer individuals. A cancer diagnosis within the past year significantly predicts higher utilization of mental health services. However, cancer diagnosis and factors are not significant predictors of prescribed psychotropic medication use. The study is limited by a lack of data on cancer stage and treatment, as well as spouses' prior mental health.
This document summarizes research on depression in early stage dementia and the development of an intervention called IDEA (Intervention to prevent Depressive symptoms and promote well-being in EArly stage dementia). It finds depression is common in dementia, with risks including age, agitation, and sleep disturbances. Existing treatments show little evidence but behavioral activation shows promise. IDEA aims to develop and test in an RCT a behavioral activation intervention for early stage dementia to prevent depression. It involves consulting people with dementia and carers to develop a treatment manual and will examine feasibility and acceptability.
This randomized controlled trial compared the effectiveness of cytisine to nicotine replacement therapy (NRT) for smoking cessation. The trial involved 1310 daily smokers who received either a 25-day course of cytisine plus behavioral support or 8 weeks of NRT plus behavioral support. The primary outcome was abstinence at 1 month, with secondary outcomes including abstinence at 2 months and 6 months. Results showed cytisine was at least as effective as NRT for smoking cessation, with abstinence rates of 40% for cytisine vs 31% for NRT at 1 month. Cytisine was also associated with longer time to relapse and fewer withdrawal symptoms compared to NRT. Adverse effects were more common but mostly
1) A clinical trial assessed whether chelation therapy improved quality of life outcomes in patients with stable coronary artery disease and a history of heart attack.
2) The trial found no consistent or sustained improvements in domains of health-related quality of life, including physical and mental functioning, with chelation therapy over 2 years of follow up.
3) A subgroup analysis found a potential benefit of chelation therapy for patients with angina symptoms at baseline, but no benefit was seen for patients with heart failure symptoms.
1. This study aimed to empower sub-district administration organizations (SDAOs) in Thailand to become health promoting organizations.
2. After implementing health promotion activities and training, SDAOM members had higher knowledge, attitudes, and enabling factors toward health promotion.
3. Many new health promotion activities emerged, health promotion plans and policies were established, and community participation increased.
Many suicidal patients do worry a lot about their reasons for contemplating suicide, about the meaning of life, about their failures, about their losses and disappointments, and they worry about their suicidal thoughts. Part of the suicidal urges are caused by the wish to stop this endless worrying and rumination. It is hypothesized that anti – worry exercises may help suicidal patients to decrease the amount of time a day that they are thinking of suicide, and therewith decrease the intensity of the reasons for contemplating suicides. In the workshop CBT techniques for worrying and rumination will be explained and applied to suicidal worrying. In the workshop participants are requested to present actual cases and engage in role playing, therewith train their skills in addressing persistent repetitive thoughts of suicide in patients.
“Talk to me”: A Self-applied Telepsychology Programme for Treatment of Fear of Public Speaking. Botella C. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
Dr. Jamie Livingston presents findings from a CREST.BD study evaluating a theatrical performance as an intervention for reducing mental illness stigma. Dr. Livingston describes details of the research design and the preliminary findings from the study's two target audiences, healthcare providers and people living with bipolar disorder. Originally presented at the Mental Health Commission of Canada's Together Against Stigma conference in Ottawa, Ontario on June 5th, 2012. Victoria Maxwell also performed her one woman stage play 'That's Just Crazy Talk' a theatrical performance which is the focus of this research.
Achieving Clinical Excellence HandoutsScott Miller
This document discusses achieving clinical excellence in psychotherapy. It provides three steps to superior performance: 1) determining your baseline effectiveness rate, 2) obtaining and using feedback to improve retention and outcomes, and 3) designing optimal practice environments and activities. It also announces the first annual "Achieving Clinical Excellence Conference" in October 2010 in Kansas City.
Cognitive Impairment in Patients Hospitalized For Acute Coronary Syndromes SA...HMO Research Network
Cognitive impairment is common in patients hospitalized for acute coronary syndromes (ACS), affecting up to 40% of patients. The current study aimed to examine the prevalence and factors associated with cognitive impairment among patients hospitalized for ACS. It found that 31% of over 1,100 ACS patients showed cognitive impairment. Older age, lower education, non-white race, high anxiety, and poorer quality of life were independently associated with cognitive impairment. The high prevalence indicates a need for increased screening and tailored care during and after hospitalization.
Incremental Cost Effectiveness of Preventing Depression in At Risk Adolescent...HMO Research Network
This document summarizes a study examining the cost-effectiveness of preventing depression in at-risk adolescents. The study involved 316 youth aged 13-17 at high risk for depression due to parental depression or their own subthreshold depressive symptoms. Participants were randomly assigned to receive either a cognitive-behavioral prevention program consisting of group therapy sessions or usual care. Outcome measures included depression-free days and quality-adjusted life years over 9 months. The study also collected cost data on the interventions, usual care services, and parents' time to assess the cost-effectiveness of the prevention program compared to usual care.
Presentation on the importance of Patient Attitudinal Research before the study progresses too far. Ask yourself: Do you know how your Protocol tastes? If it doesn't taste great to a patient or caregiver, they will never finish the study, and you have no data.
Low-income students who have been accepted to college face significant challenges
during the summer after high school. Preliminary research findings across studies indicate that
up to one-third of college-intending high school graduates either change their planned college
during the summer or fail to enroll at any college in the fall. Neither the high school nor the
college takes responsibility for students during the vulnerable summer period. This workshop
introduces participants to program interventions conducted in multiple regions in the summer of
2011 for the purpose of stemming the “summer melt” of college-intending students. Attendees
will use a model of summer intervention practices to consider the elements of effective summer
assistance and apply these principles to their own work. Detailed research results from the 2011
Boston Summer College Connects intervention will form the foundation of discussion and
group case study about best practices in summer programs and evaluation research design.
The document discusses the interplay between a therapist's personal characteristics and qualities (therapist variables) and a client's theory of change. It argues that the most effective therapy occurs when the therapist is aware of how their variables may influence the therapeutic alliance and adapts their approach to align with the client's theory of change. Case studies are presented to illustrate therapists monitoring client feedback to improve outcomes. Effective therapists recognize when their approach does not match a client's needs and make adjustments to better facilitate the client's process of change.
Dr Nicole Coupe - Preventing Māori suicide: Improving care and interventionMHF Suicide Prevention
This cultural assessment summarizes a study on preventing suicide among Māori in New Zealand. The study investigated over 700 cases of Māori suicide and self-harm annually. It formed an investigation team and advisory group to design a randomized controlled trial comparing a culturally-informed intervention ("Powhiri") to treatment as usual for Māori presenting with self-harm. Powhiri incorporated elements of Māori culture and problem-solving therapy. Preliminary findings showed Powhiri significantly decreased hopelessness and increased time before re-presentation with self-harm compared to the control group. The assessment calls for continuing to improve Māori cultural identity through culturally-informed problem solving interventions.
This study examined the prevalence and risk factors of postpartum depression among 1,379 Arab women in Qatar within 6 months of delivery. The Edinburgh Postnatal Depression Scale was used to screen participants. The prevalence of postpartum depression was found to be 17.6%. Mothers who were older, less educated, housewives, had lower incomes, maternal/infant complications, poor family/marital support, financial difficulties, prematurity, and dissatisfaction in marriage had higher rates of postpartum depression.
I understand the physician's perspective of feeling frustrated by some patient complaints. However, effective communication is a two-way street that requires effort from both medical providers and patients. Some patients may not fully understand explanations due to factors like health literacy, language barriers, or emotional states. Regular check-ins could help address such issues and improve satisfaction for all. Overall, prioritizing clear consent and ensuring patients feel heard seems key to strengthening the important relationship between doctors and those they serve.
Ecotherapy research presentation slides ukcp research conference 2013 - the...Nigel Magowan
The document summarizes a research presentation on a hermeneutic single-case efficacy design study that examined the effectiveness of nature awareness exercises as a therapeutic intervention for anxiety. Key points:
- A 51-year-old woman ("Amy") with longstanding anxiety participated in a 2-day ecotherapy workshop involving nature-based exercises.
- Data was collected before, during, and 6 weeks after via questionnaires, interviews, and therapist notes to assess changes in Amy's anxiety and other issues.
- Results showed reductions in several measures of anxiety and improvements in how Amy rated personal issues like self-criticism and assertiveness.
- Amy reported feeling improved perspective, self-worth, and
Keeping health club members - Dr. Paul Bedford, IHRSA 2009Bryan K. O'Rourke
This document summarizes research from a PhD investigating factors that affect gym membership retention. It presents data on retention rates based on member demographics and behaviors. A key finding is that having staff interact with members during visits significantly improves retention - members who received at least one interaction had a retention rate over 30% higher than those with no interactions. Interacting with members also increased their visit frequency, lengthened membership duration, and led to higher customer satisfaction ratings. The research demonstrates that gym staff proactively engaging with members can meaningfully boost retention and membership value.
Impact Evaluation Training with AERC: China Cash Transfer Programme Technical...The Transfer Project
A hypothetical technical proposal for China's conditional cash transfer programme from our impact evaluation training with AERC in Nairobi, Kenya in July 2019.
Valuing paediatric preference-based measures: using a discrete choice experim...cheweb1
This document outlines a study valuing the CHU-9D-NL, a pediatric preference-based quality of life measure, using an online discrete choice experiment with Dutch adults. It discusses challenges in valuing pediatric quality of life, including whose preferences to use and perspective to adopt. The study used adult general population preferences from their own perspective to allow comparability. Results generated sensible utility decrements, though with some inconsistencies and contrast to prior UK valuations. The study provides insights into valuing pediatric quality of life but also raises issues around appropriate perspective and population.
This document discusses DTE Energy's strategic planning for health management and implementation of a scorecard to measure programs. It outlines DTE Energy's employee population and details the development of a dashboard to track health metrics like conditions, costs, screening rates and participation. It also describes creating a scorecard to monitor goals in areas like assessments, education, biometrics, utilization and employee engagement to evaluate the impact of wellness programs.
What does the public think about assigning priority to end-of-life treatment? In this presentation, OHE's Koonal Shah describes the results of research intended to tease out both preferences and, where possible, the reasoning behind them. The findings may surprise some -- for example, that priority is not given to end-of-life treatments when the treatments they would supplant offer greater health gains.
Convocation feb 2014 uds 2 r qi slidesMarion Sills
Sills MR. Leveraging SAFTINet resources to enhance value in performance measurement. Annual Convocation of the Scalable Architecture for Federated Translational Inquiries Network (SAFTINet). Aurora, Colorado, February 2014.
For more information on SAFTINet, please see http://www.ucdenver.edu/academics/colleges/medicalschool/programs/outcomes/COHO/saftinet/Pages/default.aspx
Psychological depression prevention programs for 5-10 year olds: What’s the e...Health Evidence™
Health Evidence hosted a 90 minute webinar on psychological depression prevention programs for children and adolescents. This work received support from KT Canada funding from the Canadian Institutes of Health Research (CIHR). Key messages and implications for practice were presented.
This webinar focused on interpreting the evidence in the following review:
Merry, S., Hetrick, S.E., Cox, G.R., Brudevold-Iversen, T., Bir, J.J., & McDowell, H. (2011).Psychological and/or educational interventions for the prevention of depression in children and adolescents. Cochrane Database of Systematic Reviews, 2011(12), Art. No.: CD003380.
Kara DeCorby, Managing Director & Knowledge Broker with Health Evidence, lead the webinar.
This document discusses the importance of formulating clinical questions using the PICO framework. It provides an example of using PICO to develop a focused clinical question for a patient case. Key benefits of developing a focused clinical question include properly designing a study to answer the question, enhancing the credibility of findings, making evidence-based decisions easier, and improving retrieval and selection of relevant evidence. Overall, developing a clear clinical question using PICO improves research and supports high-quality patient care.
“Talk to me”: A Self-applied Telepsychology Programme for Treatment of Fear of Public Speaking. Botella C. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
Dr. Jamie Livingston presents findings from a CREST.BD study evaluating a theatrical performance as an intervention for reducing mental illness stigma. Dr. Livingston describes details of the research design and the preliminary findings from the study's two target audiences, healthcare providers and people living with bipolar disorder. Originally presented at the Mental Health Commission of Canada's Together Against Stigma conference in Ottawa, Ontario on June 5th, 2012. Victoria Maxwell also performed her one woman stage play 'That's Just Crazy Talk' a theatrical performance which is the focus of this research.
Achieving Clinical Excellence HandoutsScott Miller
This document discusses achieving clinical excellence in psychotherapy. It provides three steps to superior performance: 1) determining your baseline effectiveness rate, 2) obtaining and using feedback to improve retention and outcomes, and 3) designing optimal practice environments and activities. It also announces the first annual "Achieving Clinical Excellence Conference" in October 2010 in Kansas City.
Cognitive Impairment in Patients Hospitalized For Acute Coronary Syndromes SA...HMO Research Network
Cognitive impairment is common in patients hospitalized for acute coronary syndromes (ACS), affecting up to 40% of patients. The current study aimed to examine the prevalence and factors associated with cognitive impairment among patients hospitalized for ACS. It found that 31% of over 1,100 ACS patients showed cognitive impairment. Older age, lower education, non-white race, high anxiety, and poorer quality of life were independently associated with cognitive impairment. The high prevalence indicates a need for increased screening and tailored care during and after hospitalization.
Incremental Cost Effectiveness of Preventing Depression in At Risk Adolescent...HMO Research Network
This document summarizes a study examining the cost-effectiveness of preventing depression in at-risk adolescents. The study involved 316 youth aged 13-17 at high risk for depression due to parental depression or their own subthreshold depressive symptoms. Participants were randomly assigned to receive either a cognitive-behavioral prevention program consisting of group therapy sessions or usual care. Outcome measures included depression-free days and quality-adjusted life years over 9 months. The study also collected cost data on the interventions, usual care services, and parents' time to assess the cost-effectiveness of the prevention program compared to usual care.
Presentation on the importance of Patient Attitudinal Research before the study progresses too far. Ask yourself: Do you know how your Protocol tastes? If it doesn't taste great to a patient or caregiver, they will never finish the study, and you have no data.
Low-income students who have been accepted to college face significant challenges
during the summer after high school. Preliminary research findings across studies indicate that
up to one-third of college-intending high school graduates either change their planned college
during the summer or fail to enroll at any college in the fall. Neither the high school nor the
college takes responsibility for students during the vulnerable summer period. This workshop
introduces participants to program interventions conducted in multiple regions in the summer of
2011 for the purpose of stemming the “summer melt” of college-intending students. Attendees
will use a model of summer intervention practices to consider the elements of effective summer
assistance and apply these principles to their own work. Detailed research results from the 2011
Boston Summer College Connects intervention will form the foundation of discussion and
group case study about best practices in summer programs and evaluation research design.
The document discusses the interplay between a therapist's personal characteristics and qualities (therapist variables) and a client's theory of change. It argues that the most effective therapy occurs when the therapist is aware of how their variables may influence the therapeutic alliance and adapts their approach to align with the client's theory of change. Case studies are presented to illustrate therapists monitoring client feedback to improve outcomes. Effective therapists recognize when their approach does not match a client's needs and make adjustments to better facilitate the client's process of change.
Dr Nicole Coupe - Preventing Māori suicide: Improving care and interventionMHF Suicide Prevention
This cultural assessment summarizes a study on preventing suicide among Māori in New Zealand. The study investigated over 700 cases of Māori suicide and self-harm annually. It formed an investigation team and advisory group to design a randomized controlled trial comparing a culturally-informed intervention ("Powhiri") to treatment as usual for Māori presenting with self-harm. Powhiri incorporated elements of Māori culture and problem-solving therapy. Preliminary findings showed Powhiri significantly decreased hopelessness and increased time before re-presentation with self-harm compared to the control group. The assessment calls for continuing to improve Māori cultural identity through culturally-informed problem solving interventions.
This study examined the prevalence and risk factors of postpartum depression among 1,379 Arab women in Qatar within 6 months of delivery. The Edinburgh Postnatal Depression Scale was used to screen participants. The prevalence of postpartum depression was found to be 17.6%. Mothers who were older, less educated, housewives, had lower incomes, maternal/infant complications, poor family/marital support, financial difficulties, prematurity, and dissatisfaction in marriage had higher rates of postpartum depression.
I understand the physician's perspective of feeling frustrated by some patient complaints. However, effective communication is a two-way street that requires effort from both medical providers and patients. Some patients may not fully understand explanations due to factors like health literacy, language barriers, or emotional states. Regular check-ins could help address such issues and improve satisfaction for all. Overall, prioritizing clear consent and ensuring patients feel heard seems key to strengthening the important relationship between doctors and those they serve.
Ecotherapy research presentation slides ukcp research conference 2013 - the...Nigel Magowan
The document summarizes a research presentation on a hermeneutic single-case efficacy design study that examined the effectiveness of nature awareness exercises as a therapeutic intervention for anxiety. Key points:
- A 51-year-old woman ("Amy") with longstanding anxiety participated in a 2-day ecotherapy workshop involving nature-based exercises.
- Data was collected before, during, and 6 weeks after via questionnaires, interviews, and therapist notes to assess changes in Amy's anxiety and other issues.
- Results showed reductions in several measures of anxiety and improvements in how Amy rated personal issues like self-criticism and assertiveness.
- Amy reported feeling improved perspective, self-worth, and
Keeping health club members - Dr. Paul Bedford, IHRSA 2009Bryan K. O'Rourke
This document summarizes research from a PhD investigating factors that affect gym membership retention. It presents data on retention rates based on member demographics and behaviors. A key finding is that having staff interact with members during visits significantly improves retention - members who received at least one interaction had a retention rate over 30% higher than those with no interactions. Interacting with members also increased their visit frequency, lengthened membership duration, and led to higher customer satisfaction ratings. The research demonstrates that gym staff proactively engaging with members can meaningfully boost retention and membership value.
Impact Evaluation Training with AERC: China Cash Transfer Programme Technical...The Transfer Project
A hypothetical technical proposal for China's conditional cash transfer programme from our impact evaluation training with AERC in Nairobi, Kenya in July 2019.
Valuing paediatric preference-based measures: using a discrete choice experim...cheweb1
This document outlines a study valuing the CHU-9D-NL, a pediatric preference-based quality of life measure, using an online discrete choice experiment with Dutch adults. It discusses challenges in valuing pediatric quality of life, including whose preferences to use and perspective to adopt. The study used adult general population preferences from their own perspective to allow comparability. Results generated sensible utility decrements, though with some inconsistencies and contrast to prior UK valuations. The study provides insights into valuing pediatric quality of life but also raises issues around appropriate perspective and population.
This document discusses DTE Energy's strategic planning for health management and implementation of a scorecard to measure programs. It outlines DTE Energy's employee population and details the development of a dashboard to track health metrics like conditions, costs, screening rates and participation. It also describes creating a scorecard to monitor goals in areas like assessments, education, biometrics, utilization and employee engagement to evaluate the impact of wellness programs.
What does the public think about assigning priority to end-of-life treatment? In this presentation, OHE's Koonal Shah describes the results of research intended to tease out both preferences and, where possible, the reasoning behind them. The findings may surprise some -- for example, that priority is not given to end-of-life treatments when the treatments they would supplant offer greater health gains.
Convocation feb 2014 uds 2 r qi slidesMarion Sills
Sills MR. Leveraging SAFTINet resources to enhance value in performance measurement. Annual Convocation of the Scalable Architecture for Federated Translational Inquiries Network (SAFTINet). Aurora, Colorado, February 2014.
For more information on SAFTINet, please see http://www.ucdenver.edu/academics/colleges/medicalschool/programs/outcomes/COHO/saftinet/Pages/default.aspx
Psychological depression prevention programs for 5-10 year olds: What’s the e...Health Evidence™
Health Evidence hosted a 90 minute webinar on psychological depression prevention programs for children and adolescents. This work received support from KT Canada funding from the Canadian Institutes of Health Research (CIHR). Key messages and implications for practice were presented.
This webinar focused on interpreting the evidence in the following review:
Merry, S., Hetrick, S.E., Cox, G.R., Brudevold-Iversen, T., Bir, J.J., & McDowell, H. (2011).Psychological and/or educational interventions for the prevention of depression in children and adolescents. Cochrane Database of Systematic Reviews, 2011(12), Art. No.: CD003380.
Kara DeCorby, Managing Director & Knowledge Broker with Health Evidence, lead the webinar.
This document discusses the importance of formulating clinical questions using the PICO framework. It provides an example of using PICO to develop a focused clinical question for a patient case. Key benefits of developing a focused clinical question include properly designing a study to answer the question, enhancing the credibility of findings, making evidence-based decisions easier, and improving retrieval and selection of relevant evidence. Overall, developing a clear clinical question using PICO improves research and supports high-quality patient care.
Wrangle 2016: Driving Healthcare Operations with Small DataWrangleConf
By Sandy Ryza, Clover Health
How do you get people with chronic heart conditions to take their medication? Or diagnose complications as early as possible? Healthcare operations--the set of actions that organizations like insurers take to interact with their members--sit in some sort of nebulous shadow realm between social science, medicine, and corporate bureaucracy. In this talk, Sandy will throw some additional nouns that seem more at home in the modern web era, like "machine learning" and "A/B testing," into the mix. He'll also walk attendees through an example of now Clover Health builds and tests models for predicting which of diabetic members are likely to develop complications.
This document describes the development and testing of a recovery-focused cognitive behavioral therapy (RfCBT) for early-stage bipolar disorder. RfCBT was designed to explicitly target personal recovery rather than just symptom reduction. A pilot study found that RfCBT showed promise in improving personal recovery outcomes, increasing time to relapse, and enhancing quality of life compared to treatment as usual. The results provide preliminary evidence to support further evaluation of RfCBT in a larger definitive randomized controlled trial.
Binary Logistic Regression Classification makes use of one or more predictor variables that may be either continuous or categorical to predict target variable classes. This technique identifies important factors impacting the target variable and also the nature of the relationship between each of these factors and the dependent variable. It is useful in the analysis of multiple factors influencing an outcome, or other classification where there two possible outcomes.
Thinking About Success and Failure in Obesity CareObesityHelp
Even though obesity has officially been classified as disease by important groups like the American Medical Association, many people – doctors included – put all the emphasis on the scale and on other measures like body mass index (BMI). In this talk we will look at how success is measured now and other ways to define success after bariatric surgery. Time allowing, we will also talk about some of the long-term issues related to health and nutrition after bariatric surgery, with a focus on things that contribute to weight regain.
Intensive outreach-based support for adults with longstanding, complex AOD is...Uniting ReGen
2017 VAADA Conference presentation - Venetia Brissenden and Kate Petch consider ReGen's Intensive Support Service program model and the capacity of the Care & Recovery Co-ordination service type to support people with complex needs.
Dodi Kelleher (Safeway) at Consumer Centric Health, Models for Change '11HealthInnoventions
Live Life, Live Long, Live Well™
An Evolving Health and Wellness Strategy. Dodi Kelleher, DMH
Director, Health and Wellness Initiatives, Safeway Inc.
One of the largest food and drug retailers in North America
200,000 employees and 1,725 stores across the US and Canada. Safeway health benefits offered to 30,000 corporate and store employees
Consumer-Centric Design: Psychographic Segmentation and Consumer Behavior ChangeBrent Walker
This presentation was delivered by c2b solutions at the World Congress 6th Annual Leadership Conference: Consumerism through Health Plan Innovation. The presentation provides an overview of c2b solutions' proprietary psychographic segmentation model (patent pending) and its application to healthcare-oriented business cases.
This document describes a quality improvement project at Arkansas Children's Hospital to improve pediatric residents' competence and confidence in treating adult patients. Mock codes were conducted with debriefing for residents focusing on adult chest pain and stroke cases. Pre and post tests assessed increased resident knowledge, adherence to treatment guidelines, and confidence. The interventions led to improved resident performance and confidence in stabilizing acutely ill adults, though standardization of training and evaluations could strengthen future iterations.
This document summarizes a study on the effectiveness of cognitive behavioral therapy (CBT) for children in private practice. The study found that CBT significantly reduced children's behavioral problems, anxiety, and depression from pre- to post-treatment. It also increased children's ratings of well-being and therapeutic alliance. While depression symptoms decreased, they remained in the clinical range. Having more treatment sessions and including parents may further improve outcomes.
This document provides an overview of fundamental principles in quality assurance (QA) projects in the Ministry of Health. It defines key QA terms like quality assurance, quality control, and quality improvement. It discusses the QA cycle which involves problem identification, prioritization, analysis, verification, study identification, implementation of remedial actions, and monitoring. It also outlines steps in a QA study such as formulating objectives, identifying indicators, variables, criteria, and standards. Data collection techniques and types of analysis are briefly described. The document emphasizes applying a systematic approach and using data to drive continuous quality improvement in healthcare organizations.
Academy Health-Annual Research Meeting-2013-MA PCMHI: Impact on Clinical Qual...scherala
This study analyzed clinical quality measures from 45 primary care practices participating in the Massachusetts Patient-Centered Medical Home Initiative over 21 months. It found that three measures showed statistically significant improvement: screening diabetic patients for depression increased from 25.8% to 42.4%; developing action plans for children with persistent asthma increased from 19.6% to 50.7%; and creating care plans for highest risk patients increased from 36.5% to 54.2%. The initiative includes technical assistance and payment reform for practices transitioning to the patient-centered medical home model.
Similar to Seminar on Studies about Valuing End-of-Life Health Care (20)
Professor Nancy Devlin argues that the use of utility theory to value health-related quality of life (HRQoL) in cost-effectiveness analysis (CEA) warrants reexamination. While utility theory has been convention for over 30 years, its application in health economics departs from the normative foundations of CEA. Extra-welfarism permits weighting outcomes based on principles other than preferences and allows multiple stakeholders to provide values. The orthodox utility-based approach is inconsistent with extra-welfarism and utility theory choices influence results. Further, stated preference methods construct rather than reveal preferences, limiting their validity. Devlin concludes the field should refocus on simple, fit-for-purpose HRQoL measures
The document discusses the topic of price transparency in healthcare. It examines price transparency from several perspectives, including whether transparency is good as an end in itself or as a means to improve outcomes. It also discusses transparency of the price-setting process versus prices obtained, and how transparency could impact competition, collusion, and prices of off-patent versus on-patent drugs. While transparency may reduce corruption and improve competition, it also potentially facilitates collusion and could result in higher prices if it reduces firms' incentives to offer low prices.
This document discusses the role of health technology assessment (HTA) and contracting mechanisms for new antibiotic drugs to address antimicrobial resistance (AMR). It notes that HTA typically focuses on clinical trial evidence but this presents challenges for antibiotics. The document recommends that HTA for antibiotics consider additional elements of public health value and that contracting move away from volume-based payments towards delinked models. International coordination on developing new approaches to AMR drug assessment and reimbursement is encouraged.
This presentation looks at ways in which governments can set prices, including “cost plus”, value, and the external referencing of prices elsewhere. It looks at the role that competition can play in keeping down prices. In that context it briefly discusses pricing proposals being considered in Malaysia. It makes the case for using HTA to inform pricing decisions.
Adrian Towse
% GDP spending in UK, G5 countries and OECD upper middle income countries. W...Office of Health Economics
The document discusses healthcare spending in Malaysia relative to other countries. It notes that while Malaysia spends around 4% of GDP on healthcare, this is split almost evenly between public and private spending. There are pressures to increase healthcare spending due to an aging population and shift to chronic diseases. While additional investment may pay off through economic and health gains, funding needs to be increased through measures like taxes on tobacco or reducing fossil fuel subsidies. The large public-private divide and high out-of-pocket spending also need to be addressed through more strategic purchasing of healthcare services.
The role of real world data and evidence in building a sustainable & efficien...Office of Health Economics
This presentation defines RWD and RWE in the context of digital health, and looks at potential uses for RWD and RWE. It briefly sets out the current landscape in Malaysia and looks at the challenges in using RWE. In particular, the issues of access, governance and ensuring good quality are considered.
This document summarizes a symposium on capturing value across the healthcare system sponsored by PhRMA. The objective is to demonstrate why value assessment is critical for identifying gaps in value information, reducing low-value care, and measuring the value of health services. Speakers discuss expanding the focus of value assessment beyond drugs to hospital and medical services, where the majority of healthcare spending occurs. Presentations analyze factors driving rising US healthcare costs, measures of high- and low-value care, and approaches to align incentives to improve the system. The importance of robust measurement and considering stakeholder perspectives in value assessment is emphasized.
Role Substitution, Skill Mix, and Provider Efficiency and Effectiveness : Les...Office of Health Economics
Graham participated in an organised session on Monday July 15th 2019. In the session he presented his paper with his co-author Ioannis Laliotis from the London School of Economics. The paper revisits the relationship between workforce and maternity outcomes in the English NHS in an attempt to contribute knowledge to an important policy question for which there has been a paucity of research.
This research explores the feasibility of introducing an Outcome-Based Payment approach for new cancer drugs in England. A literature review explored the current funding landscape in England, the available evidence on existing OBP schemes internationally, and
which outcomes cancer patients value most. Two focus groups and an online survey with patients and carers, as well as interviews with NHS and government stakeholders, healthcare
professionals, and pharmaceutical industry representatives, provided additional evidence on the feasibility and suitability of OBP schemes
Understanding what aspects of health and quality of life are important to peopleOffice of Health Economics
Poster presentation from the EuroQol Plenary Meeting 2019, Brussels, Belgium. By Koonal Shah, Brendan Mulhern, Patricia Cubi-Molla, Bas Janssen, and David Mott.
Koonal presented as part of an organised session on ‘moving beyond conventional economic approaches in palliative and end of life care’. He summarised the empirical evidence on the extent of pubic support for an end of life premium, before discussing some novel approaches that have been used in recent studies. His presentation was discussed by Helen Mason of Glasgow Caledonian University.
Author(s) and affiliation(s): Koonal Shah, Office of Health Economics
Event: iHEA Congress
Date: 17/07/2019
Location: Basel, Switzerland
Assessing the Life-Cycle Value Added of Second Generation Antipsychotics in S...Office of Health Economics
This research presented in a poster at HTAi 2019, Cologne (Germany) by a team of OHE and IHE researchers, estimates the value added by second generation antipsychotics over their life-cycle in the UK and Sweden. It concludes that considering the entire life-cycle, the value added by SGAs to the system is higher than the expected value estimated at launch. P&R decisions should consider how to measure, capture and take into account the value added by medicines over the long-run.
Author(s) and affiliation(s): Mikel Berdud (Office of Health Economics, London), Niklas Wallin-Bernhardsson (Institute for Health Economics, Stockholm), Bernarda Zamora (Office of Health Economics, London), Peter Lindgren (Institute for Health Economics, Stockholm), Adrian Towse (Office of Health Economics, London)
Event: HTAi 2019 Annual Meeting
Date: 18/06/2019
Location: Cologne, Germany
The document discusses challenges with developing new antibiotics and incentivizing research and development. It notes that existing health technology assessment models do not fully capture the public health value of new antibiotics. It recommends that countries modify their HTA and contracting approaches to better recognize individual and societal benefits, such as preventing transmission and avoiding outbreaks. The document also recommends exploring pilots of delinked payment models from England and Sweden and applying modeling techniques used for vaccines to the assessment of antibiotics.
Assessing the Life-cycle Value Added of Second-Generation Antipsychotics in S...Office of Health Economics
This study aims to guide access decisions and drive the discussion on access and price, through recognition of the dynamic nature of value added by pharmaceutical innovation over the long-run. The analysis of the life-cycle value of risperidone estimates the value generated in the UK and Sweden. Results show that health systems were able to appropriate most of the life-cycle value generated, and this is larger than estimated at launch.
Author(s) and affiliation(s): Mikel Berdud(1), Niklas Wallin-Bernhardsson(2), Bernarda Zamora(1), Peter Lindgren(2), and Adrian Towse(1) (1) Office of Health Economics (2) The Swedish Institute for. Health Economics
Event: XXXIX JORNADAS DE ECONOMÍA DE LA SALUD
Date: 12/06/2019
Location: Albacete, Spain
This document summarizes a presentation on pay-for-performance (P4P) programs in the English National Health Service (NHS), specifically the PSS-CQUIN schemes for specialised services. PSS-CQUIN uses incentive payments to encourage quality improvement and value for money in specialised care areas like cancer treatment and mental health. The schemes link a portion of provider funding to performance indicators. While PSS-CQUIN aims to improve care quality, its complexity and lack of evidence linking indicators to outcomes are areas for improvement. An ongoing evaluation will assess PSS-CQUIN's effectiveness and cost-effectiveness to inform future contract designs.
In this session, Meng Li sets out estimates of real option value for drugs arguing that option value matters and can be calculated. Adrian Towse sets out likely payer concerns about incorporating real option value into decision making. Meng Li responds to these concerns. Jens Grueger sets out how industry considers investment opportunities, arguing that if patients (and society) have preferences these need to be reflected in P&R decisions.
Author(s) and affiliation(s): Meng Li, Postdoctoral Research Fellow, Leonard D Schaeffer Center, University of Southern California, Los Angeles, CA, USA. Adrian Towse, Emeritus Director, Office of Health Economics, London, UK Jens Grueger, formerly Head of Global Access, Senior Vice President at F. Hoffmann-La Roche
Event: ISPOR 2019
Location: New Orleans, USA
Date: 21/05/2019
MCDA OR WEIGHTED CEA BASED ON THE QALY? WHICH IS THE FUTURE FOR HTA DECISION ...Office of Health Economics
In this ISPOR session Chuck Phelps and Adrian Towse debated the case for and against using MCDA to support HTA decision making, as compared to weighting or augmenting a QALY based ICER approach. Chuck Phelps argued for use of MCDA, Adrian Towse for weighting the QALY. Nancy Devlin set the scene and moderated.
Author(s) and affiliation(s): Nancy Devlin, Director, Centre for Health Policy, University of Melbourne, Australia Adrian Towse, Emeritus Director, Office of Health Economics, London, UK Chuck Phelps, University of Rochester, Rochester, NY USA
Event: ISPOR 2019
Location: New Orleans, USA
Date: 21/05/2019
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
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Seminar on Studies about Valuing End-of-Life Health Care
1. Valuing Health at the End of Life
Koonal Shah, OHE
Rachel Baker, Glasgow Caledonian University
OHE Lunchtime Seminar
26 March 2013 • London
2. Research and Findings to Date
Koonal Shah
Office of Health Economics
OHE Lunchtime Seminar
26 March, 2013 • London
3. Study Team and Note on Funding
• This research is a collaboration between Koonal Shah (Office of
Health Economics) and Allan Wailoo, Aki Tsuchiya and Arne Risa
Hola (all University of Sheffield)
• The research was funded by the National Institute for Health and
Clinical Excellence (NICE) through its Decision Support Unit (DSU)
• The views, and any errors or omissions, expressed in this
presentation are the authors’ only
4. NICE End of Life Criteria
• Criteria that need to be satisfied for NICE’s supplementary end-
of-life policy to apply are currently as follows.
The treatment is indicated for patients with a short life
C1 expectancy, normally less than 24 months
There is sufficient evidence to indicate that the treatment offers
C2 an extension to life, normally of at least an additional three
months, compared to current NHS treatment
The treatment is licensed or otherwise indicated, for small patient
C3 populations
5. Overview of Project
Study 1: Exploratory study
• Aim: to pilot an approach to eliciting priority setting preferences
• Aim: to explore the rationales underpinning people’s stated preferences
• Small scale (n=21); convenience sample; face-to-face interviews
Study 2: Preference study
• Aim: to test whether there is public support for giving priority to end of life treatments
• Aim: to validate the approach and worth of conducting a large scale study
• Medium scale (n=50); representative sample; face-to-face interviews
Study 3: Discrete choice experiment
• Aim: to examine people’s preferences regarding end of life more robustly
• Aim: to examine the extent to which people are willing to sacrifice overall health in order to
give priority to end of life treatments
• Large scale (n=3,969); representative sample; web-based survey
6. Findings from Preliminary Studies
• Elicitation approach found to be feasible
• No consensus set of preferences
• Majority wished to give priority to the end-of-life patient, but a
sizeable minority expressed the opposite preference
• ‘No preference’ rarely expressed
• Strong preference for treatments the improve quality of life
• Preferences appear to be driven by how long patients have known
about their illness (i.e. how long they have to ‘prepare for death’)
• People are happy to prioritise based on characteristics of
patients/disease/treatment when gains to all patients are equal in
size … next step is to understand the extent to which they would
sacrifice health gain to pursue equity objectives
7. DCE Study
• DCEs (discrete choice experiments) elicit people’s preferences
based on their stated preferences in hypothetical choices
• Surveys comprise several ‘choice sets’, each containing competing
alternative ‘profiles’ described using defined ‘attributes’ and a
range of attribute ‘levels’
• Respondents’ choices between these profiles are analysed to
estimate the contribution of the attributes to overall utility
8. Attributes and Levels
Attribute Unit Levels
Life expectancy without treatment months 3, 12, 24, 36, 60
Quality of life without treatment % 50, 100
Life expectancy gain from treatment months 0, 1, 2, 3, 6, 12
Quality of life gain from treatment % 0, 25, 50
• Concept of ‘50% health’ was explained as follows:
‘Suppose there is a health state which involves some health problems. If
patients tell us that being in this health state for two years is equally
desirable as being in full health for one year, then we would describe
someone in this health state as being in 50% health’.
9. Study Design
• Forced choices (no ‘neither A nor B’ option)
• Generic descriptions of patients, illnesses and treatments
• Steps taken to avoid bias due to task order or possibility of
respondents reverting to default choices
• 10 standard DCE tasks, followed by two ‘extension tasks’ designed
specifically to explore whether respondents’ choices are influenced
by information about how long the patient has known about their
illness
10.
11.
12. Web-Based Surveys
Pros Cons
• Can recruit a vey large sample • No guarantee that respondents have
quickly and cheaply listened to or understood
• Avoids interviewer bias instructions
• Survey highly customisable – e.g. • Concerns about effort and
randomisation procedures engagement
• Quality control procedures can be • High level of drop out
put into place • Limited debriefing opportunity
• Any less likely to be representative • Concerns about representativeness
than other modes of administration? of sample
13. Background Characteristics
# % gen pop %
Total 3,969 100 100
Gender
Male 1,942 49 49
Female 2,027 51 51
Age
18-24 404 10 11
25-44 1,413 36 38
45-64 1,228 31 31
65+ 924 23 21
Social grade a
A 221 6 4
B 1,114 28 22
C1 1,150 29 29
C2 645 16 21
D 357 9 15
E 482 12 8
14. Background Characteristics (2)
# %
Household composition
With children 963 24
Without children 3,006 76
Education
No education beyond minimum school leaving age 889 22
Education beyond minimum school leaving age; no degree 1,244 31
Education beyond minimum school leaving age; degree 1,836 46
Self-reported general health level
Very good 1,008 25
Good 1,958 49
Fair 770 19
Poor 210 5
Very poor 23 1
Experience of close friends of family with terminal illness
Yes 2,689 68
No 1,197 30
Question skipped by respondent 83 2
15. Results
• Best fitting model included main effects plus three interactions:
• LE without treatment against LE gain
• Rationale: small gains in life expectancy may be increasingly important when life
expectancy without treatment is short
• LE without treatment against QOL gain
• Rationale: whether a quality of life improvement or a gain in life expectancy is
preferred may depend on life expectancy without treatment
• LE gain against QOL gain
• Rationale: the important of a gain in life expectancy may depend on whether it is
accompanied by a quality of life improvement
17. Transforming into Predicted Probabilities
• Following the approach used by Green and Gerard* we calculated
the relative predicted probabilities for all of the 110 profiles
• This allows us to compare the profiles that are likely to be most
preferred overall with those that are likely to be least preferred
overall
• The predicted probability of alternative i being chosen from the
complete set of alternatives (j=1,…,J) is given by:
𝑃𝑃𝑛𝑛𝑛𝑛 = 𝑗𝑗 = 1, … , J
𝑒𝑒 𝑉𝑉 𝑛𝑛𝑛𝑛
∑J
𝑉𝑉
𝑗𝑗=1 𝑒𝑒 𝑛𝑛𝑛𝑛
* Green, C. and Gerard, K. (2009) Exploring the social value of health care interventions: A stated
preference discrete choice experiment. Health Economics. 18(8), 951-976.
18. Estimated Utility Score and Predicted
Probability of Choice for All Profiles
Rank Rank – LE without QOL without LE gain QOL gain Utility Prob. Cumul.
- best main treatment treatment (%) (mths) (%) Prob.
fitting effects (mths)
model model
1 1 60 50 12 50 4.17809 0.0155 0.0155
2 2 36 50 12 50 4.08461 0.0154 0.0309
3 3 24 50 12 50 4.04235 0.0153 0.0462
4 5 3 50 12 50 3.95938 0.0152 0.0614
5 4 12 50 12 50 3.74493 0.0148 0.0762
6 20 3 100 12 0 3.61116 0.0145 0.0908
- - - - - - - - -
105 107 36 50 1 0 0.24171 0.0029 0.9870
106 109 12 50 1 0 0.18955 0.0028 0.9898
107 110 3 50 1 0 0.18553 0.0028 0.9926
108 104 60 50 1 0 0.13213 0.0026 0.9952
109 94 3 50 0 25 0.06320 0.0025 0.9977
110 108 24 50 1 0 -0.01452 0.0023 1.0000
19. Levels of QALYs without Treatment /
Gains Associated with All 110 Profiles
6
5
4
3
QALYs
2
1
0
0.0023 0.0040 0.0055 0.0062 0.0072 0.0085 0.0100 0.0112 0.0120 0.0130 0.0140
-1
Standardised predicted probability of being chosen
QALY without QALY gain Linear (QALY without) Linear (QALY gain)
20. Most and Least Preferred Profiles
LE without QOL without LE gain QOL gain (%) QALYs QALYs gained
treatment treatment (mths) without
(mths) (%) treatment
10 most preferred 27 55 11 38 1.14 1.76
55 most preferred 27 57 7 31 1.27 1.22
55 least preferred 27 65 2 10 1.49 0.29
10 least preferred 28 50 1 3 1.18 0.06
21. Subgroup Analysis
• We defined a selection of respondent subgroups whose choices
may be expected to differ from those of the rest of the sample
• Respondents with experience of close friends or family with terminal illness
• Respondents with responsibility for children
• Respondents who voluntarily left open-ended comments
• Respondent who completed the survey unusually quickly
• We found no substantial differences between the results for any of
these subgroups and those for the full sample
22. Categorising According to ‘Choice Strategy’
% choices made Number (%) of respondents who…
Choice strategy according to this never followed this sometimes followed always followed this
strategy strategy this strategy strategy
Choose patient with larger
QALY gain
0.75 1 (0.0%) 3,530 (88.9%) 438 (11.0%)
Choose patient with larger
LE gain
0.69 20 (0.5%) 3,405 (85.8%) 544 (13.7%)
Choose patient with fewer
QALYs without treatment
0.47 182 (4.6%) 3,701 (93.2%) 86 (2.2%)
Choose patient with less
LE without treatment
0.45 355 (8.9%) 3,434 (86.5%) 180 (4.5%)
• Multinomial logit regressions used to identify driving factor(s) behind
respondents’ membership of the ‘always / never choose patient with fewer
QALYs without treatment’ subgroup
• Marginal effects of age and health satisfaction were found to be statistically
significant, but both are small in practical terms
• As age increases, the probability of always choosing the patient with fewer QALYs
without treatment decreases, but even a 30-year increase in age would not be
sufficient for a 1% decrease in this probability
23. Extension Tasks
• Extension tasks showed that including information about the
amount of time that patients have known about their prognosis has
a clear impact on preferences
• Holding everything else constant, respondents are less likely to
choose to treat a patient if that patient has known about their
illness for two years than if they have only just found out about it
• Caveat: focusing effect may exaggerate importance
24. Summary of Findings
• Choices driven by size of health gain
• Concern about the extent to which the patient is at the end of life
appears to have a negligible effect
• Overall view seems to be that giving higher priority to those who
are worse off is desirable, but only if the gains from treatment are
substantial
• No evidence of public support for giving higher priority to end-of-
life treatments than to other types of treatments if the health gains
offered by the treatments being ‘de-prioritised’ are larger than
those offered by the end-of-life treatments
25. Caveats and Limitations
• Small range of scenarios covered – all involve poor prognoses
(some people might consider 5 years to be ‘end of life’)
• Does not necessarily refute evidence elsewhere in the literature
that people wish to pursue equity concerns
• Great deal of preference heterogeneity
• Limited opportunities for feedback and debriefing – cannot know
for certain the extent to which the choice data truly reflect
respondents’ beliefs and preferences (or whether there were
adopting heuristics)
• Framing effects clearly exist in stated preference studies
27. Institute for Applied Health Research
and
Institute for Society and Social Justice Research
Valuing health at the end of life
Shah et al
Discussion
Rachel Baker
Reader in Health Economics
rachel.baker@gcu.ac.uk
Yunus Centre for Social Business & Health
28.
29. MRC Methodology panel
Are health gains for terminally ill patients more valuable? Measuring
societal views on health care resource allocation
Rachel Baker, Neil McHugh, Helen Mason, Cam Donaldson,
Laura Williamson, Jon Godwin, Marissa Collins (GCU)
Job van Exel (Erasmus, Rotterdam)
Cathy Hutchinson (Beatson Cancer Centre, NHS Greater Glasgow &Clyde)
30. Outline
• Why this work is important
• Strengths, limitations and questions:
– Study design
– Methods
– Findings/ conclusions
• Future research…
– MRC end of life Q methodology study
31. Are equal sized health gains ‘worth’ the same
regardless of who benefits and in what ways?
32.
33.
34. Rawlins et al Brit J of
Clinical Pharmacology 2010
• “The Institute recognises that the public,
generally, places special value on treatments
that prolong life – even for a few months – at
the end of life, as long as that extension of life is
of reasonable quality (at least pain-free if not
disability-free). NICE has therefore provided its
advisory bodies with supplementary advice
about the circumstances under which they
should consider advising, as cost-effective,
treatments costing >£30,000 per QALY.” p 348
35. Study Design
• Carefully considered, rigorous design
– Preliminary and pilot work
• Choice based stated preference study
– Ordering effects and other biases controlled
– Questions blocked by choice type
• Web-based questionnaire
– Diagrams and text explanation
– Pilot tested and soft-launch
36. Methods 1: Question Framing
• Choice between two patients A and B
• Described in terms of 4 attributes
– LE and QoL without treatment
– LE and/or QoL gains with treatment
• Individuals rather than groups of patients
• QALY gain (green area)
– How is QoL gain treated/ interpreted?
• Indifference option (either not neither)
37.
38. Methods 2: Informed, C onsidered Responses
• Choice types and questions of dominance
– 13 Choice types (see table 4)
– Both patients have same LE and QoL; without treatment
one patient gains more LE and QoL (11)
• 10% respondents failed the dominance test.
– Simple error?
– Plausible rationale?
• Excluding them from the analysis did not
make any difference
39. Methods 2: Informed, Considered Responses
• Some choices between a patient who is worse off and
gains more from treatment and a patient who is
better off and gains less
• ?Not strictly dominated? QALY maximising choice
and concern for severity are the same
• 40% respondents (or in 30% of choices) chose the
patient who was better off and gained less
• Why?
• Qualitative research/ cognitive interviewing
40. Methods 2: Informed, Considered Responses
• Evidence of deliberation and carefully considered
choices .. .in web based research
– Lots of typed comments/ explanations?
– Taking time over the survey
• Speedsters!
– Problem of web-based surveys
– question of cut off...
– < 3 mins for intro, 12 DCE questions and demographics
– Quickest pilot respondent, employed/educated
people with interviewer present, 6 minutes
41. Findings 1
• Large respondent sample, lots of observations
– Any ‘representative’ sample is problematic
• Reporting of ‘raw’ data (and choice types) as well
as modelling helpful
– Table 4 (add majority choice for clarity?)
– Main effects model (table 5) shows increasing
value placed on bigger gains and
– Increasing value placed on patients with
better health without treatment (odd?)
42. Findings 2
• Main effects with 3 interactions
– Model fits better
– Table 6 is difficult to interpret…
– Instead of coefficients of attribute levels, Table 7:
110 profiles ranked according to probability of
choice
– ? Including interactions seem to take care of
‘oddness’? And untreated profile has little effect on
choice (but 40% of ‘those choice types’ are still
odd?)
– Choices driven by QoL and LE gains
43. Findings 3
• Table 8 and figures 5 and 6 summarise the
untreated QALYs and QALY gains on probability of choice
• Choice is driven by QALY gains and not untreated profile
– Add to table 7 for all 110?
– QALY gains relatively small?
– Very few levels on QoL
– Replication with different attribute levels?
• Similar to DCE findings from SVQ study
– Although modelled differently
44. Consider adding info about QALY gain
to full rank pred prob table 7?
Rank Rank LE QOL LE gain QOL gain Utility Prob. Cumul.
- best – with/ without (mths) (%) Prob.
fitting main t treatme
model effect treat nt (%) QALY gain
s (mths
mode )
l
(5*.5)+(1*1)
1 1 60 50 12 50 =3.5 4.17809 0.0155 0.0155
2 2 36 50 12 50 2 4.08461 0.0154 0.0309
3 3 24 50 12 50 2 4.04235 0.0153 0.0462
4 5 3 50 12 50 1.125 3.95938 0.0152 0.0614
5 4 12 50 12 50 1.5 3.74493 0.0148 0.0762
6 20 3 100 12 0 1 3.61116 0.0145 0.0908
- - - - - - - - -
105 107 36 50 1 0 0.04 0.24171 0.0029 0.9870
106 109 12 50 1 0 0.04 0.18955 0.0028 0.9898
107 110 3 50 1 0 0.04 0.18553 0.0028 0.9926
108 104 60 50 1 0 0.04 0.13213 0.0026 0.9952
109 94 3 50 0 25 0.06 0.06320 0.0025 0.9977
45.
46.
47. Findings 4: Extension Tasks
• 8 DCE choices selected
• Information about prior knowledge of disease added
– ?different respondents?
• Responses to the extension task questions, compared with
DCE responses suggest that time since diagnosis
is important
– We found the same in qualitative work (although not sure how
important relative to other things)
• Indifference option (either, not neither)
– Might have helped with issue of focus and
extension questions
48. Overall
• Well conducted piece of research
• Raises questions about NICE end of life policy
• Quality of life and life extension are most important
• Replication/ future research
– Stretch the attributes over a wider set of levels
• Esp LE without treatment
• Qol levels?
– Draw comparisons against patients who are
less severely ill
– Cognitive interviewing/ qualitative work and methods
to understand rationale for ‘odd choices’