„International Research Project on Financing Quality in Health Care ”

1. „International Research Project on FinancingQualityin Health Care” InterQuality WP 2 Values/Benefits (development of methodology for cost and outcome of care measurement)

2. WP2: Objectives • Main objectives are to develop consensus and guidelines on: • common terminology and conceptual framework for costs and outcomes measurement and methods of measuring costs(task 2.1) • methods of evaluating economic efficiency, based on NICE guidelines for health technology evaluation and IQWIG efficiency frontier, including guidelines for measuring patient-relevant outcomes (PRO) (task 2.2) • methods of measuring quality and equity of healthcare(task 2.3) • methods of statistical analysis across countries, differentiating between country and policy effects(task 2.4)

3. Task 2.1.common terminology and conceptual framework for costs and outcomes measurement and methods of measuring costs • In order to avoid misunderstandings definitions of terms and conceptual framework of contemplated research will be agreed by all Consortium partners • The task will start with a review of basic reference sources, like ISPOR Book of Terms • (10 Man-Months) from 3 to 5 Months of the Project • Input from MUW (38Man-Month)s from 3 to 5 Month of the Project

4. Task 2.1.common terminology and conceptual framework for costs and outcomes measurement and methods of measuring costs Need to develop standard definitions Send request to partners for 5-10 main relevant terms for development of definitions Iterative process of developing and refining definitions Define terms that are relevant across all of the health care systems that are involved Compare whether terms mean the same thing in different systems (for example, “integrated care”) Other work packages begin in month 7, so definitions are priority

5. General Literature Review Methods PubMed, EMBASE, Cochrane MESH term searches very broad – several thousand results Criteria to exclude articles – consider narrowing to last 10 years, or narrowing to participating countries Start with secondary sources – OECD, Cochrane, WHO, Cochrane, AHRQ Standard international guidelines for HTA evaluations Solicit suggestions or input from other task leaders about highest priority areas for literature review Cooperate with partners to prepare templates to describe the information that is needed from the papers that are reviewed

6. Issues related to specific literature reviews Methods of measuring costs Methods of evaluating economic efficiency • EUnetHTA • HTA bodies within participating countries (e.g., AHRQ) Methods of measuring quality of healthcare (also equity) • OECD Health Care Quality Indicators project • Health consumer powerhouse (Swedish) – questionnaires evaluating patients’ experiences with care (diabetes, CV) • European Union (EUPasnet) and EC organizations • FP7 and FP6 grant recipients (for example, ECHO) • AHRQ National Healthcare Quality Report, National Healthcare Disparities Report • WHO • AHRQ National Quality Measures Clearinghouse – 1300+ measures • National Quality Forum – qualityforum.org 600+ measures

7. How to prioritize measures of quality and equity • Measures that cut across multiple clinical domains • Measures that can be implemented across multiple participating countries • High-impact measures that address overall quality of health care system • “Running document” that can capture new ideas as they arise, and respond to new concerns and problems (use website, blog) • Questionnaires filled in by patients? (CAHPS)

8. Task 2.2.Input from collaborative partners • Partners will provide WP leader with results of review of literature perceivedas relevant to country specific health care system issues • Input into search strategy • In some cases, different WPs may implement different search strategies to address the same topic in collaboration • Establish mechanism for collaboration on literature reviews that involve multiple WPs • Input from collaborative partners (15Man-Month) from 3 to 5 Months of the Project: UI (2), MHH, UY, SDU, SPH, UniCT, CPME, EPF

9. Task 2.3. Comparative analysis of value/benefits measurement • A summary of the perceived strengths and weaknesses of methodology for cost and outcomes of care measurement will be developed • Areas of both consensus and disagreement will be identified • Indicators that can be used across multiple financing systems to permit inferences regarding impact of changes and differences • Need administrative procedure for obtaining and assimilating input from other WPs • Country-specific considerations that make particular cost and outcomes of care measurement approaches desirable or particularly problematic will be identified • For example, correlation between patient satisfaction and level of spending on health services • Identify indicators that are particularly helpful as markers of quality of health care system, and may be sensitive to payment changes • Build on WHO work

10. Task 2.4. Methodology of statistical analysis across countries & Data Warehouse • On the basis of multilevel statistical analysis methodology, recommended methods for cross country comparative analysis will be identified • Best practices (guidelines) for statistical analytic methods • What issues need to be taken into consideration? • Buy/recommend statistical packages or open source tools • Need clear question or set of questions from other WPs • Adopted methods will enable Consortium Partners to identify country and policy effects in different data sets • In order to collect and analyze statistical data in uniform format, dedicated Data Warehouse will be prepared and used by all project participants • Will be implemented locally at MUW, accessible to all partners • Encourage more data to be available for research in Poland

11. WP2:Deliverables 1. Catalogue of definitions related toquality, equity, outcomes and costs evaluation as well as comparative value/benefit analysis (Guidelineson comparativeevaluation) 2. Data WarehousewithGuidelines on statistical analysis across countries, differentiation between country and policy effects in different data sets, taking into consideration data availability and respecting confidentially requirements