Themed Discussion and Panel Debate

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• Themed Discussion and Panel Debate
• Is there a way to measure the effectiveness and
  implementation of integrated care for people with
  a chronic illness?
• Gothenborg, 6 March 2008

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Agenda

• General introduction Bert Vrijhoef
• Brief presentations by panel members
• Hélène Trouvé
• Viktoria Stein
• Susanne Kümpers
• Discussion with
• panel members and audience

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• Measuring effectiveness effective measuring
• integrated care
• Dr H.J.M. Vrijhoef PhD
• University Centre Maastricht, The Netherlands
• Gothenborg, 6 March 2008

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Background

• Care for chronically ill Quantity Quality
• Emerging approaches DMP, integrated care, case
  management, stepped care, etc.
• Claims for benefits
• Adoption not as fast as might be expected

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Substantial room for quality improvement!
McGlynn et al. NEJM 2003 3482635-45
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Background

• Care for chronically ill Quantity Quality
• Emerging approaches DMP, integrated care, case
  management, stepped care, etc.
• Claims for benefits
• Adoption not as fast as might be expected

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Background

• Care for chronically ill Quantity Quality
• Emerging approaches DMP, integrated care, case
  management, stepped care, etc.
• Claims for benefits Which claims?
• Adoption not as fast as might be expected
  Implications for evaluation/ research?

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Claims Quality

• Steuten, Vrijhoef, Spreeuwenberg et al. Int J
  Tech Assess Health Care 20062247-57
• limited number of studies of moderate
  methodological quality
• in substantial part of studies no link exists
  between the aim of a DMP and evaluated indicators
• efficiency is mainly evaluated by process
  indicators and not by outcome indicators
• to better understand DMPs evaluations should be
  better designed
• include structure, processes and outcomes
• nature of DMP (aim) defines focus
• introduction of framework which proposes minimum
  data sets to enable (better) decision making on
  DMPs

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Claims ROI or business case

• Luck et al. J Gen Intern Med 200722396-402
• the published literature does not provide clear
  evidence that mechanisms to improve care for
  patients with complex conditions have a
  favourable business case.
• whereas most studies ..measure processes of
  care, outcomes and/or patient satisfaction, only
  a minority measure costs and financial benefits
• Mattke et al. Am J Manag Care 200713670-6
• to date support for population-based DM is more
  an article of faith than a reasoned conclusion
  grounded on well-reasoned facts.

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Conclusions

• limited number of studies with multiple
  methodological shortcomings claims?
• the object of study includes evidence based
  medicine and feedback mechanisms as constituting
  components expectations vs. experiences?
• huge challenge for research/ evaluations!
  bridging gap between claims and adoption?

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Scientific challenge

• No universally accepted evaluation methods to
  measure and report programme performance in a
  scientifically sound fashion that is also
  practicable for routine operations
• Aim To provide evidence-based recommendations to
  policymakers, programme operators and researchers
  on which evaluation approach is most useful in a
  given context
• How? Overview the approaches to chronic care and
  disease management evaluation methods (across
  Europe) and to test and validate possible
  evaluation approaches using currently existing
  programmes (international proposal)

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Agenda

• General introduction Bert Vrijhoef
• Brief presentations by panel members
• Hélène Trouvé
• Viktoria Stein
• Susanne Kümpers
• QA/ discussion by
• panel members and audience