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.
The Importance of measuring outcomes, including Patient Reported Outcome Measures (PROMS)
BAOT Lifelong Learning Event
10 November 2010
Dr Alison Laver-Fawcett
Head of Programme, BHSC(Hons) Occupational Therapy
York St John University
Evidence Based Practice Lecture 7_slidesZakCooper1
This document discusses how evidence-based practice is used in clinical settings through clinical practice guidelines and decision analysis. It defines clinical practice guidelines as a series of steps for providing clinical care and decision analysis as a formal structure for integrating evidence about treatment options. Clinical practice guidelines aim to standardize and improve care but have limitations such as not applying to complex patients. Decision analysis allows for elucidating optimal individual decisions but requires significant time and resources. Overall, evidence-based practice provides tools and approaches to inform clinical decision-making.
Reducing saturated fat intake for cardiovascular disease: What's the evidence? Health Evidence™
Health Evidence hosted a 60 minute webinar examining the effect of reducing saturated fat intake for cardiovascular disease. Click here for access to the audio recording for this webinar: https://youtu.be/Zwe_JF7Aqb8
Lee Hooper, Reader in Research Synthesis, Nutrition & Hydration in the Norwich Medical School at the University of East Anglia lead the session and presented findings from her latest Cochrane review:
Hooper L., Martin N., Abdelhamid A., & Smith G.D. (2015). Reduction in saturated fat intake for cardiovascular disease . Cochrane Database of Systematic Reviews, 2015, CD011737.
Public health recommendations for fat reduction and modification as prevention of cardiovascular disease have changed little over time. This Cochrane review examines the effect of reducing saturated fat intake through modification on cardiovascular morbidity and mortality through 15 randomised control trials. 17 comparisons with 59,000 participants demonstrate a 17% (RR 0.83; 95% CI 0.72 to 0.96) reduction of cardiovascular events by reducing dietary saturated fat. This webinar will examine the effect of replacing saturated fat with carbohydrate, polyunsaturated and monounsaturated fat on cardiovascular morbidity and mortality, and explore future recommendations.
This document summarizes a capstone project that assessed the knowledge of RN case managers regarding evidence-based nutritional guidelines for heart failure patients. A survey was distributed to RN case managers to evaluate their confidence level and knowledge of guidelines around sodium and fluid intake. The results identified several knowledge deficits and indicated a need for increased education and support from leadership to ensure nurses have the most up-to-date clinical guidelines. Suggested changes included implementing regular educational requirements for nurses and allocating more time for nurses to obtain necessary knowledge to properly educate patients.
Incorporating EBM in Residency TrainingImad Hassan
Here are the key points from the article:
- Handheld ultrasound and BNP testing are useful screening tools for detecting LV dysfunction in dyspneic patients.
- Using both tests together improves diagnostic accuracy compared to using either test alone.
- Point-of-care testing allows for rapid diagnosis and treatment decisions to be made during the ward round or clinic visit.
- Early identification of LV dysfunction can help initiate appropriate therapy and management for heart failure.
- Using evidence-based screening with ultrasound and BNP supports efficient, accurate clinical decision making during ward rounds.
RECENT EVIDENCE BASED PRACTICES IN NURSING & CHALLENGES ENCOUNTERED IN NURSIN...Asokan R
The document discusses evidence-based practices in nursing. It begins by defining evidence-based practice and outlining the key components of EBP, which include best research evidence, clinical expertise, and patient values. Recent examples of EBP in nursing are then provided, such as optimal techniques for blood pressure measurement and gastric tube placement verification. Challenges to implementing EBP are also examined, like lack of knowledge, negative attitudes towards research, and organizational constraints.
An integrated model of psychosocial cancer care: a work in progress…Cancer Institute NSW
Cancer patients are faced with a multitude of stressors, from diagnosis, through treatment, at recurrence, in the stages following treatment completion, and in the terminal phase. Psychosocial care has been highlighted as a critical aspect of providing comprehensive patient-focused care. Specifically, one of the goals of The NSW Cancer Plan 2011-2015 is to improve the quality of life of people with cancer and their carers. This project was initiated to improve the current psychosocial model of care at The Kinghorn Cancer Centre (TKCC), to better reflect an integrated, holistic and comprehensive model of patient-centred care.
The Importance of measuring outcomes, including Patient Reported Outcome Measures (PROMS)
BAOT Lifelong Learning Event
10 November 2010
Dr Alison Laver-Fawcett
Head of Programme, BHSC(Hons) Occupational Therapy
York St John University
Evidence Based Practice Lecture 7_slidesZakCooper1
This document discusses how evidence-based practice is used in clinical settings through clinical practice guidelines and decision analysis. It defines clinical practice guidelines as a series of steps for providing clinical care and decision analysis as a formal structure for integrating evidence about treatment options. Clinical practice guidelines aim to standardize and improve care but have limitations such as not applying to complex patients. Decision analysis allows for elucidating optimal individual decisions but requires significant time and resources. Overall, evidence-based practice provides tools and approaches to inform clinical decision-making.
Reducing saturated fat intake for cardiovascular disease: What's the evidence? Health Evidence™
Health Evidence hosted a 60 minute webinar examining the effect of reducing saturated fat intake for cardiovascular disease. Click here for access to the audio recording for this webinar: https://youtu.be/Zwe_JF7Aqb8
Lee Hooper, Reader in Research Synthesis, Nutrition & Hydration in the Norwich Medical School at the University of East Anglia lead the session and presented findings from her latest Cochrane review:
Hooper L., Martin N., Abdelhamid A., & Smith G.D. (2015). Reduction in saturated fat intake for cardiovascular disease . Cochrane Database of Systematic Reviews, 2015, CD011737.
Public health recommendations for fat reduction and modification as prevention of cardiovascular disease have changed little over time. This Cochrane review examines the effect of reducing saturated fat intake through modification on cardiovascular morbidity and mortality through 15 randomised control trials. 17 comparisons with 59,000 participants demonstrate a 17% (RR 0.83; 95% CI 0.72 to 0.96) reduction of cardiovascular events by reducing dietary saturated fat. This webinar will examine the effect of replacing saturated fat with carbohydrate, polyunsaturated and monounsaturated fat on cardiovascular morbidity and mortality, and explore future recommendations.
This document summarizes a capstone project that assessed the knowledge of RN case managers regarding evidence-based nutritional guidelines for heart failure patients. A survey was distributed to RN case managers to evaluate their confidence level and knowledge of guidelines around sodium and fluid intake. The results identified several knowledge deficits and indicated a need for increased education and support from leadership to ensure nurses have the most up-to-date clinical guidelines. Suggested changes included implementing regular educational requirements for nurses and allocating more time for nurses to obtain necessary knowledge to properly educate patients.
Incorporating EBM in Residency TrainingImad Hassan
Here are the key points from the article:
- Handheld ultrasound and BNP testing are useful screening tools for detecting LV dysfunction in dyspneic patients.
- Using both tests together improves diagnostic accuracy compared to using either test alone.
- Point-of-care testing allows for rapid diagnosis and treatment decisions to be made during the ward round or clinic visit.
- Early identification of LV dysfunction can help initiate appropriate therapy and management for heart failure.
- Using evidence-based screening with ultrasound and BNP supports efficient, accurate clinical decision making during ward rounds.
RECENT EVIDENCE BASED PRACTICES IN NURSING & CHALLENGES ENCOUNTERED IN NURSIN...Asokan R
The document discusses evidence-based practices in nursing. It begins by defining evidence-based practice and outlining the key components of EBP, which include best research evidence, clinical expertise, and patient values. Recent examples of EBP in nursing are then provided, such as optimal techniques for blood pressure measurement and gastric tube placement verification. Challenges to implementing EBP are also examined, like lack of knowledge, negative attitudes towards research, and organizational constraints.
An integrated model of psychosocial cancer care: a work in progress…Cancer Institute NSW
Cancer patients are faced with a multitude of stressors, from diagnosis, through treatment, at recurrence, in the stages following treatment completion, and in the terminal phase. Psychosocial care has been highlighted as a critical aspect of providing comprehensive patient-focused care. Specifically, one of the goals of The NSW Cancer Plan 2011-2015 is to improve the quality of life of people with cancer and their carers. This project was initiated to improve the current psychosocial model of care at The Kinghorn Cancer Centre (TKCC), to better reflect an integrated, holistic and comprehensive model of patient-centred care.
The document discusses the EQ-5D, a standardized instrument used to measure health outcomes. It describes the EQ-5D as comprising a descriptive system covering 5 dimensions of health and a visual analog scale (EQ-VAS). Country-specific value sets allow EQ-5D health states to be converted into a single summary index number representing health-related quality of life. The EQ-5D is widely used internationally in cost-effectiveness analysis and other areas to inform healthcare decisions. Challenges in analyzing EQ-5D data and future directions for outcomes measurement are also addressed.
What is implementation science and why should you careLisa Muldrew
This document provides an overview of implementation science and its aims to develop strategies for improving health processes and outcomes. It discusses the translation continuum from pre-intervention to dissemination and implementation studies. Key factors that impact successful implementation include context, innovation characteristics, recipients, and facilitation. This is illustrated through a clinical case example where a study called ASSIST used a multifaceted strategy including a quality improvement team and external facilitator to successfully improve metabolic monitoring rates for patients on antipsychotics from 70% to over 90%.
1) Evidence based practice is a process through which scientific evidence is identified, appraised and applied in health care interventions to provide the best patient care.
2) It involves forming a team to develop, implement and evaluate an evidence based plan, searching databases to retrieve evidence, grading the strength of evidence, and developing standards for practice.
3) Barriers to evidence based practice include lack of time, administrative support, and difficulty changing practice habits, but it can improve patient and organizational outcomes when implemented successfully.
Introduction of the NZ Health IT Plan enables better gout management - Reflections of an early adopter. Presented by Peter Gow, Counties Manukau DHB, at HINZ 2014, 12 November 2014, 11.37am, Plenary Room
This document summarizes a presentation on patient-reported outcome (PRO) measures for diabetes clinical trials. It discusses how PROs can provide real-world data on factors like treatment adherence. Two presenters are introduced: Paul O'Donohoe, who develops health outcomes expertise at CRF Health, and Dr. Keith Meadows, a health psychologist who founded DHP Research. The presentation covers choosing between generic and condition-specific PROs, conceptual frameworks for PROs, and an example measure called the Diabetes Health Profile (DHP) that assesses diabetes' psychological and lifestyle impacts.
Health-related effects of government tobacco control policies: What's the evi...Health Evidence™
Health Evidence hosted a 90 minute webinar examining the effectiveness of government tobacco control policies promoted by the Framework Convention on Tobacco Control on health-related outcomes. Click here for access to the audio recording: https://youtu.be/oMBERrVazGY
Steven J. Hoffman, Director of Global Strategy Lab and Associate Professor of Law at the University of Ottawa and Charlie Tan, MD Candidate, Michael G. DeGroote School of Medicine, McMaster University, led the session and presented findings from their latest BMC Public Health review:
Hoffman SJ, & Tan C. (2015). Overview of systematic reviews on the health-related effects of government tobacco control policies. BMC Public Health, 15(744).
The global tobacco epidemic is a major public health problem that continues to deepen, with nearly 1 billion smokers worldwide in 2012. Government interventions are critical to addressing the global tobacco epidemic as it is the leading cause of preventable death, resulting in approximately 6 million unnecessary deaths per year. This review examines the effectiveness of government tobacco control policies promoted by the Framework Convention on Tobacco Control (FCTC), supporting the implementation of this international treaty on the tenth anniversary of it entering into force. This webinar highlighted factors that contribute to the effectiveness of government tobacco control policies as well as implications for practice.
This document discusses the distinctions, synergies, and infrastructures needed to optimize patient outcomes through evidence based practice, research, and quality improvement. It compares the problem solving processes of quality improvement, evidence based practice, and clinical research. Quality improvement uses a systematic, data-driven approach to improve processes and outcomes, while evidence based practice involves using the best available research evidence, clinical expertise, and patient preferences to make decisions. Clinical research aims to generate generalizable knowledge through systematic study and evaluation. Infrastructure characteristics like mentorship, leadership, and culture can promote high quality outcomes, evidence uptake, and clinical inquiry.
This document proposes a community-based intervention called "Get out Live, Love Life: Park 30" aimed at increasing physical activity. It will enhance an urban park and conduct outreach to educate community members. Baseline surveys will assess park usage and safety concerns. Partnerships will be formed and the park improved. Marketing will publicize the changes and physical activity recommendations. Participants will complete pre- and post-tests to evaluate stage of physical activity change according to the Transtheoretical Model. The goal is for the intervention to create a supportive environment that increases park use and physical activity levels in the community.
Using Implementation Science to transform patient care (Knowledge to Action C...NEQOS
Master Class presentation and workshop materials from the NENC AHSN Collaborating for Better Care Partnership's Master Class, led by Professor Jeremy Grimshaw' on 1st September 2014
Exercise programs for people with dementia: What's the evidence?Health Evidence™
Health Evidence hosted a 90 minute webinar examining the effectiveness of exercise programs for people with dementia. Click here for access to the audio recording: https://youtu.be/jC8HhC2XFrE
Dorothy Forbes, Professor, Faculty of Nursing, University of Alberta, Edmonton led the session and presented findings from her latest Cochrane review:
Forbes, D., Forbes, S. C., Blake, C. M., Thiessen, E. J., & Forbes, S. (2015). Exercise programs for people with dementia. Cochrane Database of Systematic Reviews, 2015(4), CD006489.
As the population ages, the number of people suffering with dementia will also rise. Not only will this affect quality of life of people with dementia but will also increase the burden of family caregivers, community care, and residential care services. Exercise interventions have been identified as a potential way of reducing or delaying the progression of dementia and its symptoms. This review examines two questions: do exercise programs for older people with dementia improve cognition, activities of daily living (ADLs), challenging behaviour, depression, and mortality in older people with dementia? and; do exercise programs for older people with dementia have an indirect impact on family caregivers' burden, quality of life, and mortality?
Colorectal screening evidence & colonoscopy screening guidelines Health Evidence™
Health Evidence hosted a 90 minute webinar examining colorectal cancer screening: benefits and harms, effective screening methods, and screening guidelines.Click here for access to the audio recording for this webinar: https://www.youtube.com/watch?v=JqOV-KHCBq8
Donna Fitzpatrick-Lewis, MSW, Senior Research Coordinator at the McMaster Evidence Review and Synthesis Centre and Dr. Maria Bacchus, Associate Professor of Medicine, Faculty of Medicine University of Calgary, and member of the Canadian Task Force on Preventive Health Care led the session. Donna presented the findings of the Synthesis Centre’s latest review and Dr. Bacchus presented findings from the Task Force’s latest guidelines:
Fitzpatrick-Lewis, D., Usman, A., Warren, R., Kenny, M., Rice, M., Bayer, A., Ciliska, D., Sherifali, D., Raina, P. Screening for colorectal cancer. Ottawa: Canadian Task Force on Preventive Health Care; 2015. Available: http://canadiantaskforce.ca/files/crc-screeningfinal2.pdf
Bacchus, C. M., Dunfield, L., Gorber, S. C., Holmes, N. M., Birtwhistle, R., Dickinson, J. A., Lewin, G., Singh, H., Klarenbach, S., Mai, V., Tonelli, M. (2016). Recommendations on screening for colorectal cancer in primary care. Canadian Medical Association Journal, cmaj-151125.
Among men and women, colorectal cancer is the second and third most common cause of cancer related death, respectively. Colorectal cancer screening guidelines, developed by the Canadian Task Force on Preventive Health Care, are based on a systematic review synthesizing evidence on the benefits and harms of screening, and the characteristics of effective screening tests. The guidelines, developed from the review, outline screening recommendations for adults aged 50 and older who are asymptomatic and not at high risk for colorectal cancer. This webinar provided a high level overview of the systematic review that informed these recommendations, followed by an overview of the recent Canadian screening guidelines.
This document summarizes recommendations from major clinical guidelines regarding screening for nutrition-related conditions. It reviews guidelines from the Canadian Task Force on Preventative Health Care, US Preventative Services Task Force, and Canadian Diabetes Clinical Guidelines. The recommendations are organized by age group and include the grade of recommendation and level of evidence. Several evidence-based screening recommendations are highlighted, such as screening newborns for PKU and hemoglobin screening for high-risk pregnant women. The tables provide a useful reference for practitioners on nutrition screening and suggested interventions.
Clinical Questions types .
A Hierarchy of Preprocessed Evidence.
EBM definition and value.
Knowledge and Skills Necessary for Optimal Evidence-Based Practice.
Basic computer and internet knowledge for electronic searching of the literature
Construction of an Implementation Science for Scaling Out Interventions HopkinsCFAR
This document discusses the construction of implementation science for scaling out interventions. It begins by illustrating the use of team science and practice networks in implementation research. It then discusses adding the concept of scaling out to the traditional research pipeline for implementation, which involves transporting evidence-based interventions to new service delivery systems and contexts. Two options for research and practice involving scaling out are presented: a static model which focuses on strict adherence to programs, and a dynamic model which allows for planned adaptation. The document argues for the dynamic model and discusses approaches like ADAPT-ITT and the dynamic adaptation process for evaluating interventions during the scaling out process. It emphasizes the need to evaluate both implementation and effectiveness when scaling out.
The document summarizes a feasibility study on implementing a SNAP (smoking, nutrition, alcohol, physical activity) intervention model in general practices across two health divisions in Australia. It found that:
1) General practitioners reported being more confident in motivational interviewing and SNAP interventions after receiving training and support.
2) Recording and management of patient risk factors improved, though sustainability was limited by a lack of practice teamwork and funding model to support ongoing SNAP activities.
3) Divisions of general practice could play a role in improving support, resources and collaboration to help practices provide behavioral interventions.
This document summarizes 5 research studies that will impact clinical practice for academic family physicians. It discusses studies on appropriate use of antithrombotic medication in atrial fibrillation patients, the association between neighborhood walkability and rates of overweight/obesity/diabetes, predictors of frequent primary care visits among older patients, differences in patient experience survey responses based on survey delivery method, and a randomized trial on oral/topical antibiotics for infected eczema in children. The document analyzes the research questions, methods, findings and implications of each study.
Implementation science aims to study methods to promote the uptake of evidence-based practices into routine healthcare. It focuses on evaluating the process of implementation and its impact on the targeted evidence-based practice. Implementation studies commonly employ mixed quantitative and qualitative methods to evaluate the process, formative outcomes, and summative impact of implementation strategies. Key outcomes include measures of adoption rates, fidelity, costs and sustainability of implementing evidence-based practices into real-world healthcare settings.
The document summarizes a literature review on valuing health at the end of life. It finds mixed evidence from 17 studies on whether the public wishes to place greater value on health gains for end-of-life patients compared to others. While some studies find evidence for an "end of life premium", others find no such evidence. Most studies did not examine preferences for quality of life improvements versus life extensions for end-of-life patients. The review identifies gaps in the literature and calls for further research using multiple methods to test the robustness of findings.
Methods for Observational Comparative Effectiveness Research on Healthcare De...Marion Sills
Research Objective: The SAFTINet project was funded by the AHRQ to build a distributed network of existing clinical and claims data that would support comparative effectiveness research (CER), with a focus on underserved populations and healthcare delivery system (HDS) characteristics. Observational research methods are appropriate, but require detailed protocols with a priori hypotheses and analytic plans. SAFTINet research specifically concerns the effects of a discrete set of HDS features (those often included in Patient-Centered Medical Home (PCMH) models) on health outcomes for primary care patients with asthma, hypertension, and hypercholesterolemia. Our objective is to present a description of this study’s measurement challenges, and to specify a priori hypotheses, analytic strategies, and plans for addressing bias and confounding for our asthma cohorts.
Study Design: An observational, longitudinal cohort study of primary care patients with asthma, with both secondary use of existing clinical and claims data and primary data collection for HDS features and patient- reported outcomes.
Population Studied: Our sample consists of 59 primary care practices in 5 healthcare organizations in Colorado, Utah and Tennessee; all practices serve underserved populations. These practices care for about 275,000 patients per year, of whom an estimated 22,000 have a diagnosis of asthma.
Principal Findings: We will present the processes used to define and measure the HDS features, covariates and asthma outcomes, along with planned analysis. Challenges include valid measurement of a multi-faceted HDS “exposure” variable, the inability to identify exposure onset, and the non-dichotomous nature of HDS characteristics. To measure HDS characteristics, we created a practice-level survey assessing 9 PCMH domains, including care coordination, specialty care and mental health integration, and patient-centeredness, as well as asthma-specific HDS characteristics (e.g., the use of asthma registries). Asthma outcomes included (1) those available as a result of routine electronic documentation of clinical care and claims administration (utilization indicative of an exacerbation), and (2) patient reported outcomes tools (Asthma Control Test). We used directed acyclic graphs to identify potential confounders of the relationship between HDS characteristics and asthma control, as well as other potential biases. The analytic plan is based on linear mixed effects models. Perspectives of the CER team, the technology team and the community engagement group were considered in the operationalization of all variables.
Conclusions: The design of rigorous observational CER observational CER should recognize the need for an intense planning phase. In accordance with good practice guidance for observational studies, an important component of the planning phase is to disseminate and obtain feedback on the research design in advance of its conduct.
This document describes a study that used a discrete choice experiment with duration (DCEtto) to value health states described by the EQ-5D-5L instrument in Canada. It notes limitations of the traditional time trade-off (TTO) method, such as many respondents not understanding or engaging with the task. The study found the DCEtto method led to fewer exclusions, increasing representativeness. Health state values from the DCEtto were generally lower than the TTO but allowed valuing all respondents. The document discusses differences in the distributions and average levels of values from the two methods and impact of exclusions. It acknowledges limitations to interpreting DCEtto values that require further investigation.
The document discusses the EQ-5D, a standardized instrument used to measure health outcomes. It describes the EQ-5D as comprising a descriptive system covering 5 dimensions of health and a visual analog scale (EQ-VAS). Country-specific value sets allow EQ-5D health states to be converted into a single summary index number representing health-related quality of life. The EQ-5D is widely used internationally in cost-effectiveness analysis and other areas to inform healthcare decisions. Challenges in analyzing EQ-5D data and future directions for outcomes measurement are also addressed.
What is implementation science and why should you careLisa Muldrew
This document provides an overview of implementation science and its aims to develop strategies for improving health processes and outcomes. It discusses the translation continuum from pre-intervention to dissemination and implementation studies. Key factors that impact successful implementation include context, innovation characteristics, recipients, and facilitation. This is illustrated through a clinical case example where a study called ASSIST used a multifaceted strategy including a quality improvement team and external facilitator to successfully improve metabolic monitoring rates for patients on antipsychotics from 70% to over 90%.
1) Evidence based practice is a process through which scientific evidence is identified, appraised and applied in health care interventions to provide the best patient care.
2) It involves forming a team to develop, implement and evaluate an evidence based plan, searching databases to retrieve evidence, grading the strength of evidence, and developing standards for practice.
3) Barriers to evidence based practice include lack of time, administrative support, and difficulty changing practice habits, but it can improve patient and organizational outcomes when implemented successfully.
Introduction of the NZ Health IT Plan enables better gout management - Reflections of an early adopter. Presented by Peter Gow, Counties Manukau DHB, at HINZ 2014, 12 November 2014, 11.37am, Plenary Room
This document summarizes a presentation on patient-reported outcome (PRO) measures for diabetes clinical trials. It discusses how PROs can provide real-world data on factors like treatment adherence. Two presenters are introduced: Paul O'Donohoe, who develops health outcomes expertise at CRF Health, and Dr. Keith Meadows, a health psychologist who founded DHP Research. The presentation covers choosing between generic and condition-specific PROs, conceptual frameworks for PROs, and an example measure called the Diabetes Health Profile (DHP) that assesses diabetes' psychological and lifestyle impacts.
Health-related effects of government tobacco control policies: What's the evi...Health Evidence™
Health Evidence hosted a 90 minute webinar examining the effectiveness of government tobacco control policies promoted by the Framework Convention on Tobacco Control on health-related outcomes. Click here for access to the audio recording: https://youtu.be/oMBERrVazGY
Steven J. Hoffman, Director of Global Strategy Lab and Associate Professor of Law at the University of Ottawa and Charlie Tan, MD Candidate, Michael G. DeGroote School of Medicine, McMaster University, led the session and presented findings from their latest BMC Public Health review:
Hoffman SJ, & Tan C. (2015). Overview of systematic reviews on the health-related effects of government tobacco control policies. BMC Public Health, 15(744).
The global tobacco epidemic is a major public health problem that continues to deepen, with nearly 1 billion smokers worldwide in 2012. Government interventions are critical to addressing the global tobacco epidemic as it is the leading cause of preventable death, resulting in approximately 6 million unnecessary deaths per year. This review examines the effectiveness of government tobacco control policies promoted by the Framework Convention on Tobacco Control (FCTC), supporting the implementation of this international treaty on the tenth anniversary of it entering into force. This webinar highlighted factors that contribute to the effectiveness of government tobacco control policies as well as implications for practice.
This document discusses the distinctions, synergies, and infrastructures needed to optimize patient outcomes through evidence based practice, research, and quality improvement. It compares the problem solving processes of quality improvement, evidence based practice, and clinical research. Quality improvement uses a systematic, data-driven approach to improve processes and outcomes, while evidence based practice involves using the best available research evidence, clinical expertise, and patient preferences to make decisions. Clinical research aims to generate generalizable knowledge through systematic study and evaluation. Infrastructure characteristics like mentorship, leadership, and culture can promote high quality outcomes, evidence uptake, and clinical inquiry.
This document proposes a community-based intervention called "Get out Live, Love Life: Park 30" aimed at increasing physical activity. It will enhance an urban park and conduct outreach to educate community members. Baseline surveys will assess park usage and safety concerns. Partnerships will be formed and the park improved. Marketing will publicize the changes and physical activity recommendations. Participants will complete pre- and post-tests to evaluate stage of physical activity change according to the Transtheoretical Model. The goal is for the intervention to create a supportive environment that increases park use and physical activity levels in the community.
Using Implementation Science to transform patient care (Knowledge to Action C...NEQOS
Master Class presentation and workshop materials from the NENC AHSN Collaborating for Better Care Partnership's Master Class, led by Professor Jeremy Grimshaw' on 1st September 2014
Exercise programs for people with dementia: What's the evidence?Health Evidence™
Health Evidence hosted a 90 minute webinar examining the effectiveness of exercise programs for people with dementia. Click here for access to the audio recording: https://youtu.be/jC8HhC2XFrE
Dorothy Forbes, Professor, Faculty of Nursing, University of Alberta, Edmonton led the session and presented findings from her latest Cochrane review:
Forbes, D., Forbes, S. C., Blake, C. M., Thiessen, E. J., & Forbes, S. (2015). Exercise programs for people with dementia. Cochrane Database of Systematic Reviews, 2015(4), CD006489.
As the population ages, the number of people suffering with dementia will also rise. Not only will this affect quality of life of people with dementia but will also increase the burden of family caregivers, community care, and residential care services. Exercise interventions have been identified as a potential way of reducing or delaying the progression of dementia and its symptoms. This review examines two questions: do exercise programs for older people with dementia improve cognition, activities of daily living (ADLs), challenging behaviour, depression, and mortality in older people with dementia? and; do exercise programs for older people with dementia have an indirect impact on family caregivers' burden, quality of life, and mortality?
Colorectal screening evidence & colonoscopy screening guidelines Health Evidence™
Health Evidence hosted a 90 minute webinar examining colorectal cancer screening: benefits and harms, effective screening methods, and screening guidelines.Click here for access to the audio recording for this webinar: https://www.youtube.com/watch?v=JqOV-KHCBq8
Donna Fitzpatrick-Lewis, MSW, Senior Research Coordinator at the McMaster Evidence Review and Synthesis Centre and Dr. Maria Bacchus, Associate Professor of Medicine, Faculty of Medicine University of Calgary, and member of the Canadian Task Force on Preventive Health Care led the session. Donna presented the findings of the Synthesis Centre’s latest review and Dr. Bacchus presented findings from the Task Force’s latest guidelines:
Fitzpatrick-Lewis, D., Usman, A., Warren, R., Kenny, M., Rice, M., Bayer, A., Ciliska, D., Sherifali, D., Raina, P. Screening for colorectal cancer. Ottawa: Canadian Task Force on Preventive Health Care; 2015. Available: http://canadiantaskforce.ca/files/crc-screeningfinal2.pdf
Bacchus, C. M., Dunfield, L., Gorber, S. C., Holmes, N. M., Birtwhistle, R., Dickinson, J. A., Lewin, G., Singh, H., Klarenbach, S., Mai, V., Tonelli, M. (2016). Recommendations on screening for colorectal cancer in primary care. Canadian Medical Association Journal, cmaj-151125.
Among men and women, colorectal cancer is the second and third most common cause of cancer related death, respectively. Colorectal cancer screening guidelines, developed by the Canadian Task Force on Preventive Health Care, are based on a systematic review synthesizing evidence on the benefits and harms of screening, and the characteristics of effective screening tests. The guidelines, developed from the review, outline screening recommendations for adults aged 50 and older who are asymptomatic and not at high risk for colorectal cancer. This webinar provided a high level overview of the systematic review that informed these recommendations, followed by an overview of the recent Canadian screening guidelines.
This document summarizes recommendations from major clinical guidelines regarding screening for nutrition-related conditions. It reviews guidelines from the Canadian Task Force on Preventative Health Care, US Preventative Services Task Force, and Canadian Diabetes Clinical Guidelines. The recommendations are organized by age group and include the grade of recommendation and level of evidence. Several evidence-based screening recommendations are highlighted, such as screening newborns for PKU and hemoglobin screening for high-risk pregnant women. The tables provide a useful reference for practitioners on nutrition screening and suggested interventions.
Clinical Questions types .
A Hierarchy of Preprocessed Evidence.
EBM definition and value.
Knowledge and Skills Necessary for Optimal Evidence-Based Practice.
Basic computer and internet knowledge for electronic searching of the literature
Construction of an Implementation Science for Scaling Out Interventions HopkinsCFAR
This document discusses the construction of implementation science for scaling out interventions. It begins by illustrating the use of team science and practice networks in implementation research. It then discusses adding the concept of scaling out to the traditional research pipeline for implementation, which involves transporting evidence-based interventions to new service delivery systems and contexts. Two options for research and practice involving scaling out are presented: a static model which focuses on strict adherence to programs, and a dynamic model which allows for planned adaptation. The document argues for the dynamic model and discusses approaches like ADAPT-ITT and the dynamic adaptation process for evaluating interventions during the scaling out process. It emphasizes the need to evaluate both implementation and effectiveness when scaling out.
The document summarizes a feasibility study on implementing a SNAP (smoking, nutrition, alcohol, physical activity) intervention model in general practices across two health divisions in Australia. It found that:
1) General practitioners reported being more confident in motivational interviewing and SNAP interventions after receiving training and support.
2) Recording and management of patient risk factors improved, though sustainability was limited by a lack of practice teamwork and funding model to support ongoing SNAP activities.
3) Divisions of general practice could play a role in improving support, resources and collaboration to help practices provide behavioral interventions.
This document summarizes 5 research studies that will impact clinical practice for academic family physicians. It discusses studies on appropriate use of antithrombotic medication in atrial fibrillation patients, the association between neighborhood walkability and rates of overweight/obesity/diabetes, predictors of frequent primary care visits among older patients, differences in patient experience survey responses based on survey delivery method, and a randomized trial on oral/topical antibiotics for infected eczema in children. The document analyzes the research questions, methods, findings and implications of each study.
Implementation science aims to study methods to promote the uptake of evidence-based practices into routine healthcare. It focuses on evaluating the process of implementation and its impact on the targeted evidence-based practice. Implementation studies commonly employ mixed quantitative and qualitative methods to evaluate the process, formative outcomes, and summative impact of implementation strategies. Key outcomes include measures of adoption rates, fidelity, costs and sustainability of implementing evidence-based practices into real-world healthcare settings.
The document summarizes a literature review on valuing health at the end of life. It finds mixed evidence from 17 studies on whether the public wishes to place greater value on health gains for end-of-life patients compared to others. While some studies find evidence for an "end of life premium", others find no such evidence. Most studies did not examine preferences for quality of life improvements versus life extensions for end-of-life patients. The review identifies gaps in the literature and calls for further research using multiple methods to test the robustness of findings.
Methods for Observational Comparative Effectiveness Research on Healthcare De...Marion Sills
Research Objective: The SAFTINet project was funded by the AHRQ to build a distributed network of existing clinical and claims data that would support comparative effectiveness research (CER), with a focus on underserved populations and healthcare delivery system (HDS) characteristics. Observational research methods are appropriate, but require detailed protocols with a priori hypotheses and analytic plans. SAFTINet research specifically concerns the effects of a discrete set of HDS features (those often included in Patient-Centered Medical Home (PCMH) models) on health outcomes for primary care patients with asthma, hypertension, and hypercholesterolemia. Our objective is to present a description of this study’s measurement challenges, and to specify a priori hypotheses, analytic strategies, and plans for addressing bias and confounding for our asthma cohorts.
Study Design: An observational, longitudinal cohort study of primary care patients with asthma, with both secondary use of existing clinical and claims data and primary data collection for HDS features and patient- reported outcomes.
Population Studied: Our sample consists of 59 primary care practices in 5 healthcare organizations in Colorado, Utah and Tennessee; all practices serve underserved populations. These practices care for about 275,000 patients per year, of whom an estimated 22,000 have a diagnosis of asthma.
Principal Findings: We will present the processes used to define and measure the HDS features, covariates and asthma outcomes, along with planned analysis. Challenges include valid measurement of a multi-faceted HDS “exposure” variable, the inability to identify exposure onset, and the non-dichotomous nature of HDS characteristics. To measure HDS characteristics, we created a practice-level survey assessing 9 PCMH domains, including care coordination, specialty care and mental health integration, and patient-centeredness, as well as asthma-specific HDS characteristics (e.g., the use of asthma registries). Asthma outcomes included (1) those available as a result of routine electronic documentation of clinical care and claims administration (utilization indicative of an exacerbation), and (2) patient reported outcomes tools (Asthma Control Test). We used directed acyclic graphs to identify potential confounders of the relationship between HDS characteristics and asthma control, as well as other potential biases. The analytic plan is based on linear mixed effects models. Perspectives of the CER team, the technology team and the community engagement group were considered in the operationalization of all variables.
Conclusions: The design of rigorous observational CER observational CER should recognize the need for an intense planning phase. In accordance with good practice guidance for observational studies, an important component of the planning phase is to disseminate and obtain feedback on the research design in advance of its conduct.
This document describes a study that used a discrete choice experiment with duration (DCEtto) to value health states described by the EQ-5D-5L instrument in Canada. It notes limitations of the traditional time trade-off (TTO) method, such as many respondents not understanding or engaging with the task. The study found the DCEtto method led to fewer exclusions, increasing representativeness. Health state values from the DCEtto were generally lower than the TTO but allowed valuing all respondents. The document discusses differences in the distributions and average levels of values from the two methods and impact of exclusions. It acknowledges limitations to interpreting DCEtto values that require further investigation.
Consumers' willingness to pay for improved water services in ilorin metropoli...Alexander Decker
This document summarizes a study that assessed consumers' willingness to pay for improved water services in Ilorin, Nigeria. Key findings include:
- The mean willingness to pay of households for improved water services was 1023.18 naira. Age, education, and price significantly influenced willingness to pay.
- Access to potable water was estimated at 58% in urban areas of Kwara state but only 12% in rural areas. Water infrastructure was poorly maintained.
- There is a large "water gap" in Kwara state between available water and needs, which must be addressed to meet Millennium Development Goals for water access.
This document discusses using a discrete choice experiment with duration (DCEtto) to estimate health state utility values on the QALY scale. It notes that generic preference-based measures like EQ-5D may not be sensitive enough, and DCE studies have not produced QALY values. The new DCEtto method embeds duration into a DCE to estimate QALY values. A case study applying DCEtto to rheumatoid arthritis treatments is presented, showing reasonable results. Limitations include larger variance than TTO and questions around incorporating results into economic evaluation.
This document summarizes key concepts related to demand and supply analysis. It discusses how demand curves are determined by individual consumer willingness to pay and how market demand is the sum of individual demands. Supply is based on costs, including fixed and variable costs, and the marginal cost curve determines the short-run supply. Market equilibrium occurs where demand and supply intersect, establishing an equilibrium price and quantity. The document also briefly discusses factors like elasticity, profitability, and barriers to entry and exit in markets with imperfect competition.
The document summarizes the emerging picture of "value-based pricing" proposals from the UK government to set medicine prices based on factors like clinical effectiveness, cost effectiveness, disease burden, innovation level, and wider societal benefits. It discusses how these value elements could be measured, aggregated, and linked to price, noting options like weighted QALYs, multi-criteria decision analysis, and net monetary benefit. It also examines implications for potential thresholds, negotiations, patient access schemes, and whether this approach signifies major change or just a name change.
How to Run Discrete Choice Conjoint AnalysisQuestionPro
This webinar provided an overview of how to conduct discrete choice conjoint analysis. It discussed the theory and logic behind conjoint analysis, when to use it, how to design a conjoint study including attributes and levels, how to write the questionnaire, how to analyze results to determine relative attribute importance and utility values, and tips for a successful project including using qualitative research first, sample size considerations, and best practices for surveys. The webinar also demonstrated how to set up a conjoint analysis question, different design types, and how to use the market simulator tool to predict how new product concepts may perform.
Introduction to Design of Experiments by Teck Nam Ang (University of Malaya)Teck Nam Ang
This set of slides explains in a simple manner the purpose of experiment, various strategies of experiment, how to plan and design experiment, and the handling of experimental data.
The document provides guidance on writing the discussion section of a research paper. It should interpret results using evidence from the study and existing knowledge. Significant findings should be described and any differences from expectations explained. The discussion draws conclusions based on results and suggests future directions while acknowledging limitations. It relates findings to prior work and considers alternative explanations.
The document outlines the steps for planning and conducting data analysis, including determining the method of analysis, processing and interpreting the data, and presenting the findings through descriptive and inferential statistical analysis techniques to answer research questions. It also discusses the components and format for writing up the final research paper, including the preliminary pages, main body, and supplementary pages.
Evidence-Based Practice Guidelines and Shared Decision Making: Conflicting or...Zackary Berger
How can we bridge physician guidelines, based on the best available evidence, and patient preferences? This workshop was given at the Society of General Internal Medicine 2015 Annual Meeting in Toronto, Canada.
Session Coordinator: Zackary Berger, MD, PhD
Additional Faculty: Michael J. Barry, MD, Kathleen Fairfield, MD, Leigh H. Simmons, MD, James Yeh, MD, Daniella A. Zipkin, MD, Dave deBronkart
Population Health Management PHM MLCSU huddleMatthew Grek
Andi Orlowski (Director of The Health Economics Unit) give an overview of Population Health Management (PHM) to the Midlands and Lancashire Commissioning Support Unit Huddle, on 25 March 2021
SHARE Webinar: Why Should I Join a Clinical Trial with Dr. Hershmanbkling
Dr. Dawn L. Hershman of the Herbert Irving Comprehensive Cancer Center at Columbia University presented the basics of clinical trials and emphasized how important it is for more patients to participate in them. She also discussed trials currently available for early stage and metastatic breast cancers. The webinar was presented on June 25, 2014. To hear the webinar, visit www.sharecancersupport.org/hershman
Technologies that enhance the precision and effect of therapies can make a critical contribution to ensuring value for money and improving patient care. Methods and processes for assessing value, however, still are imperfect. This presentation reviews the challenges and identifies some approaches for meeting them.
Presented in:
Pre-Conference Workshop on Communication Skills in Management of Cancer Patients,
World Cancer Day Conference & Expo 2015
by National Cancer Society of Malaysia
This document discusses health-related quality of life (HRQOL) and how it is measured. Some key points:
1. HRQOL assessments evaluate how medical treatments impact patients' overall well-being and ability to function, not just clinical outcomes like survival. It is a multidimensional concept.
2. Valid and reliable HRQOL instruments use standardized questions across domains to accurately capture patients' perceptions over time. Instruments must demonstrate properties like reliability, validity, and responsiveness to change.
3. Comparing HRQOL scores to appropriate comparison groups and clinically meaningful thresholds is important for interpreting results in research and clinical practice. Both general and disease-specific HRQOL instruments are used.
Evidence for Public Health Decision MakingVineetha K
The presentation gives an overview of evidence based public health with emphasis on the seven steps of EBPH Framework. It also includes the data sources to search for evidence and relevant articles explaining the current trend in decision making. One of the sources of the presentation is from EBPH training series by Rocky Mountain foundation. The link is provided in the end slide. Do contact me if you need any help with the resources.
The document summarizes Martina Garau's presentation on assessing the value of co-dependent technologies such as diagnostic tests and treatments. It discusses how co-dependent technologies can create additional value dimensions beyond traditional cost-effectiveness analysis, challenges to valuing and proving the benefits of these technologies, and examples from countries like Australia and the UK. The presentation analyzes frameworks for capturing different value elements, barriers to evidence generation, and proposes processes for jointly assessing diagnostics and treatments.
This document summarizes a presentation on physician assessment and retraining through a collaboration between the KSTAR program and JPS Health Network. It provides background on physician re-entry to practice after an absence, outlines the KSTAR assessment process and mini-residency program at JPS, and shares demographic data and outcomes of the first 28 physicians who completed the program. The collaboration uses a comprehensive assessment to determine physicians' needs and place them in a 3-month mini-residency to address areas for improvement before returning to unrestricted practice. Most physicians are able to complete the program successfully and return to patient care.
DOES SOCIETY WISH TO PLACE GREATER WEIGHT ON A UNIT OF HEALTH GAIN FOR END OF...Office of Health Economics
- This literature review finds an equal split between studies that report evidence consistent with an end of life 'premium' where greater weight is placed on health gains for end of life patients, and studies that do not find evidence for this premium. The evidence is mixed. Factors like the preference elicitation method used and whether indifference options or visual aids were included could impact the likelihood of a study finding an end of life premium. Given framing effects, the researchers recommend using multiple methods to test the robustness of results on valuing health gains for end of life patients.
The Wellness Beyond Cancer Program at The Ottawa Hospital aims to provide colorectal cancer patients with appropriate follow-up care after treatment completion through a survivorship care plan. The program includes a needs assessment, education classes, discharge letters to primary care providers, and three levels of follow-up care. An evaluation of the first year found high patient satisfaction with education and empowerment. The program aims to improve cancer survivor care coordination and transition patients to wellness. Key lessons include considering incentives and barriers to ensure long-term sustainability and appropriate use of health resources.
Valuing health states associated with chronic disorders of consciousness shah...Office of Health Economics
This presentation reviews current methods for capturing how the general public values health states as background for discussion on applying these to chronic disorders of consciousness.
This document outlines the key steps in conducting a clinical trial:
1. Drawing up a detailed research protocol that serves as the trial's operating manual.
2. Selecting and screening participants according to eligibility criteria to identify the study population. Sample size is also calculated.
3. Randomly allocating the study participants into experimental and control groups through a process like randomization to reduce bias.
How to Define Effective and Efficient Real World TrialsTodd Berner MD
This document discusses strategies for designing effective and efficient real-world clinical trials. It covers topics such as using real-world evidence to inform clinical trial design, the differences between efficacy and effectiveness, challenges around representativeness in trial populations, and the value of pragmatic clinical trials. It also discusses leveraging electronic health records for condition-specific prompts and clinical decision support to improve performance and quality of care.
How to design effective and efficient real world trials TB Evidence 2014 10.2...Todd Berner MD
This document discusses strategies for designing effective and efficient real-world clinical trials. It covers topics such as using real-world evidence to inform clinical trial design, the differences between efficacy and effectiveness, challenges in defining quality metrics, and strategies for improving performance within healthcare systems. The document provides information on pragmatic clinical trials and how real-world evidence could reduce costs compared to traditional clinical trials.
Dr Yen-Fu Chen's presentation on publication bias in service delivery research for the CLAHRC WM Scientific Advisory Group, 10th June 2015, Birmingham, UK
Behaviour change techniques targeting diet and physical activity in type 2 di...Health Evidence™
Health Evidence hosted a 60 minute webinar examining the behaviour change techniques (BCTs) and features of dietary and physical activity interventions associated with reducing HbA1c in people with type 2 diabetes. Click here for access to the audio recording for this webinar: https://youtu.be/Fb6_t7_TGxw
Kevin Cradock, PhD student, National University of Ireland, Galway led the session and presented findings from his recent systematic review:
Cradock K, OLaighin G, Finucane F, Gainforth H, Quinlan L, & Ginis K. (2017). Behaviour change techniques targeting both diet and physical activity in type 2 diabetes: A systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 18.
Changing diet and physical activity behaviour is one of the cornerstones of type 2 diabetes treatment, but changing behaviour is challenging. The objective of this study was to identify behaviour change techniques (BCTs) and intervention features of dietary and physical activity interventions for patients with type 2 diabetes that are associated with changes in HbA1c. Thirteen RCTs were identified. Diet and physical activity interventions achieved clinically significant reductions in HbA1c at three and six months, but not at 12 and 24 months. Specific BCTs and intervention features identified may inform more effective structured lifestyle intervention treatment strategies for type 2 diabetes.
The Chronic Care Model provides a framework to improve care for patients with chronic illnesses. It emphasizes productive interactions between informed, activated patients and prepared practice teams. The model includes six core elements: community resources, self-management support, delivery system design, decision support, clinical information systems, and organized healthcare systems. Studies show practices that more fully implement the model through interventions experience improved quality of care and patient outcomes. Randomized controlled trials demonstrate the Chronic Care Model is effective across different chronic conditions. While implementation presents challenges, the evidence indicates the Chronic Care Model can successfully redesign care for chronic illness.
> Why HEOR?
> Costs, Consequences and Perspectives
> Key Stakeholders in HEOR
> What is Health Economics and Pharmaco-economic Research?
> Economic Evaluations
> Incremental Cost Effectiveness Ratio (ICER)
> Concept of HRQoL
> Comparative Effectiveness Research (CER)
> Pragmatic Clinical Trials
> Observational Studies
> Systematic Reviews and Meta-Analysis
> Application of CER
> Health Technology Assessment (HTA)
> Real World Evidence (RWE)
> Patient Reported Outcomes (PROs)
> Patient Focused Drug Development (PFDD)
> Application of Health Economic Evaluations
> Challenges and Barriers
The document discusses reasons for offering medical treatment and measuring health-related quality of life (HRQoL). It provides three key reasons for treatment: to increase longevity, prevent future illness, and improve how patients feel. Measuring HRQoL directly assesses patients' physical and mental health over time and daily functioning. Investigators have developed questionnaires to measure HRQoL domains like physical, psychological, and social functioning. Choosing the right HRQoL measure depends on the study purpose, with generic measures used for population surveys and disease-specific ones for clinical trials.
Similar to Valuing Health at the End of Life: Defining Public Preferences (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
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
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Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
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Valuing Health at the End of Life: Defining Public Preferences
1. Valuing Health at the End of Life
A Stated Preference Discrete Choice Experiment
Koonal Shah
Heath Economics Research Centre Seminar Series
University of Oxford • 21 January 2014
2. Study team and note on funding
• This study is a collaboration with Allan Wailoo and Aki
Tsuchiya (both University of Sheffield)
• The study was funded by the National Institute for Health
and Care Excellence (NICE) through its Decision Support
Unit
• The views, and any errors or omissions, expressed in this
presentation are those of the authors only
Valuing health at the end of life (HERC seminar)
21/01/2013 2
3. 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:
C1
The treatment is indicated for patients with a short
life expectancy, normally less than 24 months
C2
There is sufficient evidence to indicate that the
treatment offers an extension to life, normally of at
least an additional three months, compared to current
NHS treatment
C3
The treatment is licensed, or otherwise indicated for,
small patient populations
Valuing health at the end of life (HERC seminar)
21/01/2013 3
4. NICE end-of-life criteria (2)
• Placing additional weight on survival benefits in patients
with short remaining life expectancy could be considered a
valid representation of society's preferences
• But the NICE consultation revealed concerns that little
scientific evidence supports this premise
Valuing health at the end of life (HERC seminar)
21/01/2013 4
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
Valuing health at the end of life (HERC seminar)
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6. Scenario 1
Both patients are same age today (Time=0)
Time
(years)
0
1
2
3
4
5
6
7
8
9
10
11
Patient A
Patient B
denotes time in full quality of life
denotes life extension (at full quality of life) achievable from treatment
Valuing health at the end of life (HERC seminar)
21/01/2013 6
7. Scenario 2
Patient B is 9 years older than patient A today
Time
(years)
0
1
2
3
4
5
6
7
8
9
10
11
Patient A
Patient B
Valuing health at the end of life (HERC seminar)
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8. Scenario 3
Both patients are same age today
Time
(years)
-9
-8
-7
-6
-5
-4
-3
-2
-1
0
1
A
B
Valuing health at the end of life (HERC seminar)
21/01/2013 8
2
9. Scenario 4
Both patients are same age today (30 years old)
Time
(years)
0
1
2
A
B
denotes life extension (at 50% quality of life) achievable from treatment
denotes improvement from 50% quality of life to full quality of life
achievable from treatment
Valuing health at the end of life (HERC seminar)
21/01/2013 9
10. Scenario 5
Both patients are same age today (70 years old)
Time
(years)
0
1
2
A
B
Valuing health at the end of life (HERC seminar)
21/01/2013 10
11. Scenario 6
Patient B is 9 years older than patient A today
Time
(years)
0
1
2
3
4
5
6
7
8
9
10
A
B
Valuing health at the end of life (HERC seminar)
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12. 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
• Preference for treatments that 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
Valuing health at the end of life (HERC seminar)
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13. DCE study
• DCEs elicit people’s preferences based on their stated
preferences given 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
Valuing health at the end of life (HERC seminar)
21/01/2013 13
14. 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’.
Valuing health at the end of life (HERC seminar)
21/01/2013 14
15. 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
patients have known about their illness
Valuing health at the end of life (HERC seminar)
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18. Web-based surveys
Pros
•
•
•
•
•
Can recruit a vey large
sample quickly and cheaply
Avoids interviewer bias
Survey highly customisable –
e.g. randomisation
procedures
Quality control procedures
can be put into place
Any less likely to be
representative than other
modes of administration?
Cons
•
•
•
•
•
No guarantee that
respondents have read or
understood instructions
Concerns about effort and
engagement
High level of drop out
Limited debriefing
opportunity
Concerns about
representativeness of sample
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20. Background characteristics (2)
#
963
3,006
Household composition
With children
Without children
Education
No education beyond minimum school leaving age
Education beyond minimum school leaving age; no degree
Education beyond minimum school leaving age; degree
Self-reported general health level
Very good
Good
Fair
Poor
Very poor
Experience of close friends or family with terminal illness
Yes
No
Question skipped by respondent
%
24
76
889
1,244
1,836
22
31
46
1,008
1,958
770
210
23
25
49
19
5
1
2,689
1,197
83
68
30
2
Valuing health at the end of life (HERC seminar)
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21. 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
Valuing health at the end of life (HERC seminar)
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23. 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 =
𝑒𝑒 𝑉𝑉 𝑛𝑛𝑛𝑛
𝑉𝑉
∑J
𝑒𝑒 𝑛𝑛𝑛𝑛
𝑗𝑗=1
𝑗𝑗 = 1, … , J
* Green, C. and Gerard, K., 2009. Exploring the social value of health care interventions: a
stated preference discrete choice experiment. Health Economics, 18(8), pp. 951-976.
Valuing health at the end of life (HERC seminar)
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24. Estimated utility score and predicted
probability of choice for all profiles
Rank
- best
fitting
model
Rank –
main
effects
model
LE without
treatment
(mths)
QOL without
treatment
(%)
LE gain
(mths)
QOL gain
(%)
Utility
Prob.
Cumul.
Prob.
-
-
60
36
24
3
12
3
-
50
50
50
50
50
100
-
12
12
12
12
12
12
-
50
50
50
50
50
0
-
4.17809
4.08461
4.04235
3.95938
3.74493
3.61116
0.0155
0.0154
0.0153
0.0152
0.0148
0.0145
0.0155
0.0309
0.0462
0.0614
0.0762
0.0908
0.0029
0.0028
0.0028
0.0026
0.0025
0.9870
0.9898
0.9926
0.9952
0.9977
110
108
24
50
1
0
0.0023
1.0000
1
2
3
4
5
6
105
106
107
108
109
1
2
3
5
4
20
107
109
110
104
94
36
12
3
60
3
50
50
50
50
50
1
1
1
1
0
0
0
0
0
25
-
0.24171
0.18955
0.18553
0.13213
0.06320
0.01452
-
-
Valuing health at the end of life (HERC seminar)
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25. Levels of QALYs without treatment /
gains associated with all 110 profiles
6
5
QALYs
4
3
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)
Valuing health at the end of life (HERC seminar)
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26. Most and least preferred profiles
LE
without
treatment
(mths)
QOL
LE gain
without
(mths)
treatment
(%)
QOL gain
(%)
QALYs
QALYs
without
gained
treatment
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
10 most
preferred
Valuing health at the end of life (HERC seminar)
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27. 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
•
Respondents 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
Valuing health at the end of life (HERC seminar)
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28. Categorising according to ‘choice strategy’
Number (%) of respondents who…
% choices made
according to this
strategy
never followed this
strategy
sometimes followed
this strategy
always followed this
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%)
Choice strategy
•
•
Multinomial logit regressions used to identify driving factor(s) behind
respondents’ membership in the subgroup ‘always / never choose patient
with fewer QALYs without treatment’
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
Valuing health at the end of life (HERC seminar)
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29. 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 who has know about
their illness for two years than if the patient has only just
found out about their illness
• Caveat: focusing effect may exaggerate importance
Valuing health at the end of life (HERC seminar)
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30. Extension tasks (2)
•
The above figure shows the impact on choices of providing information on
how long patients have known about their illness, summed across all 16
extension tasks
Valuing health at the end of life (HERC seminar)
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31. 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 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 ‘deprioritised’ are larger than those offered by the end of life
treatments
Valuing health at the end of life (HERC seminar)
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32. 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
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