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Transcript of 1 Lecture #1 Introduction to Outcomes and Effectiveness Research January 5, 2015 (9:00-11:50 am) HPM...
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1
Lecture #1 Introduction to Outcomes
and Effectiveness Research
January 5, 2015 (9:00-11:50 am)
HPM 214 http://hpm214.med.ucla.edu/
911 Broxton Avenue
Los Angeles, CA 90024
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HPM 214 Schedule
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01/05/15 Introduction to Outcomes and Effectiveness Research, and
Patient-Reported Outcomes
Fung & Hays (2008); Reeve et al. (2013)
01/12/15 HRQOL Profile Measures Hays & Revicki (2005 chapter); Hays & Reeve (2010)
01/19/15 MLK Holiday Ganz et al. (2014)
01/26/15 HRQOL Preference-Based Measures (Quiz)
Feeny (2005, chapter); Kaplan et al. (2011)
02/02/15 Designing HRQOL Measures McColl (2005 chapter)02/09/15 Evaluating HRQOL Measures Hays & Fayers (2005 chapter);
Hays & Revicki (2005 chapter)
02/16/15 Presidents’ Day Holiday
Improving HRQOL inDialysis patients
http://www.kidney.org/professionals/CFCs.cfm
02/23/15 PROMIS/IRT/Internet Panels Cappelleri et al. (2014); Cella et al. (2010)
03/02/15 Responding to reviews of submitted manuscripts;
Cognitive Interview questions
Example of reviews received, resubmitted article and cover letter
03/09/15 Course Review (Cognitive Interview write-ups due)
---------------------------------
03/16/15 Final Exam* 9-11:50am ----------------------------------
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HPM 214 Assignments
• Class participation (25%)
• Two class assignments (25%)– Complete the SF-36 v2 survey at
http://www.sf-36.org/demos/SF-36v2.html – Conduct and summarize 5 cognitive interviews with
a self-administered HRQOL survey.
• Extra credit (2-page critique of published HRQOL article).
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Final Exam (50% of grade)• Which of the following could be a patient-reported measure (PRM)?
– Social support
– Satisfaction with health care
– Income
– Adherence to medical recommendations
– All of the above
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U.S. Health Care Issues
• Access to care – ~ 50 million people without health insurance
• Costs of care– Expenditures ~ $ 2.7 Trillion
• Effectiveness (quality) of care5
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How Do We Know If Care Is Effective?
• Effective care maximizes probability of
desired health outcomes
– Health outcome measures indicate whether
care is effective
Cost ↓
Effectiveness ↑
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What Are Health Outcomes?
• Traditional clinical endpoints– Death, disease occurrence, other adverse events
– Clinical measures/biological indicators• Blood pressure• Blood hemoglobin level• Symptoms (e.g. fever)
• Health-Related Quality of Life
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HRQOL is Multi-Dimensional
HRQOL
Physical Mental Social
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Health-Related Quality of Life (HRQOL)
How the person FEELs (well-being)• Emotional well-being• Pain• Energy
What the person can DO (functioning)• Self-care • Role • Social
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HRQOL is Not
Quality of environment
Type of housing
Level of income
Social Support
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Social Support
People sometimes look to others for companionship, assistance, or other types of support. How often were each of the following kinds of support available to you when you needed it during the past four weeks?
– Someone to turn to for help with a personal problem? – Someone to help with daily chores if you were sick? – Someone to love and make you feel wanted?
All of the Time Most of the Time Some of the Time A Little of the Time
None of the Time
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Patient-Reported Outcomes (PROs)
“Any report coming from patients about a health condition and its treatment”(U.S. FDA, 2006)
Including• Health-related quality of life (HRQOL)• Satisfaction with treatment• Patient reports about care• Needs assessment• Adherence to treatment
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Patient-Reported Outcomes (PROs)
“Any report coming from patients about a health condition and its treatment”(U.S. FDA, 2006)
Including• Health-related quality of life (HRQOL)• Satisfaction with treatment• Patient reports about care• Needs assessment• Adherence to treatment
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Patient-Reported Measures (PRMs)
• Background characteristics– Age, education, income
• Health care experiences– Reports about care (e.g., communication)
• Behavior– Adherence to physician recommendations
• Outcomes– Satisfaction with care– HRQOL
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HRQOLHRQOL
HealthHealthBehaviorsBehaviors
(Adherence)(Adherence)
HealthHealthBehaviorsBehaviors
(Adherence)(Adherence)
Technical Technical QualityQuality
Technical Technical QualityQuality
Satisfaction With Care
Satisfaction With Care
Quality of CareQuality of Care
Patient Patient Reports Reports
About CareAbout Care
Patient Patient Reports Reports
About CareAbout Care
Patient Patient CharacteristicsCharacteristics
Patient Patient CharacteristicsCharacteristics
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Uses of HRQOL Measures
• Monitoring population (and subgroups)
• Observational studiesObservational studies
• Clinical trials Clinical trials
• Clinical practiceClinical practice
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HS 214, Winter 01·11·10
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Behavioral Risk Factor Surveillance System (BRFSS)
• Telephone interview (random digit dialing) of nationwide survey of U.S. adults
• % reporting poor or fair health about 16%
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Greater % of fair or poor health reported Greater % of fair or poor health reported by older adults (33% for 75+ vs. 9% for 18-24)by older adults (33% for 75+ vs. 9% for 18-24)
Greater % of fair or poor health reported Greater % of fair or poor health reported by older adults (33% for 75+ vs. 9% for 18-24)by older adults (33% for 75+ vs. 9% for 18-24)
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Greater % of fair or poor health Greater % of fair or poor health reported reported
by females (17%) than males (15%) by females (17%) than males (15%)
Greater % of fair or poor health Greater % of fair or poor health reported reported
by females (17%) than males (15%) by females (17%) than males (15%)
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Uses of HRQOL Measures
• Monitoring population (and subgroups)Monitoring population (and subgroups)
• Observational studies
• Clinical trials Clinical trials
• Clinical practiceClinical practice
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Observational Study
•Observation of groups •(non-random assignment)
Outcomes
•Clinical•Complications•Survival •HRQOL
Casemix adjustment needed• + Conditions/comorbidity • + Severity• + Demographics•
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Observational Studies
ProcessOf CareProcessOf Care
OutcomesOutcomes
Patient-Patient-ReportedReportedPatient-Patient-
ReportedReported ClinicalClinicalClinicalClinical Patient-Patient-ReportedReportedPatient-Patient-
ReportedReportedExpertExpert
ConsensusConsensusExpertExpert
ConsensusConsensus
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Process of Care
• Expert Consensus – Quality of Care “If, Then” Indicators
• % of patients with diabetes with one or more HbA1c tests annually
• Patient reports about communication – In the last 12 months, how often did your doctor
explain things in a way that was easy to understand?
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Outcomes of Care
• Clinical– % of patients with diabetes with most recent HbA1c
level >9.0% ( poor control)
• Patient global rating of health– Would you say that in general your health is:
Excellent | Very good | Good | Fair | Poor
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Uses of HRQOL Measures
• Monitoring population (and subgroups)Monitoring population (and subgroups)
• Observational studiesObservational studies
• Clinical trialsClinical trials
• Clinical practice Clinical practice
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Randomized Trial Design• Outcomes
– Clinical
– Complications
– Survival
– HRQOL
• Little control for case-mix required
StudyPopulation
RandomizeRandomize
Intervention Group
Control Group
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Uses of HRQOL Measures
• Monitoring population (and subgroups)Monitoring population (and subgroups)
• Observational studiesObservational studies
• Clinical trials Clinical trials
• Clinical practice
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HRQOL Assessment by Providers May
• Facilitate patient-physician communication• Improve clinician understanding of patients’ problems
(particularly those of a psychosocial nature)
Detmar SB, Aaronson NK. Quality of life assessment in daily clinical oncology practice: a feasibility study. Eur J Cancer. 1998;34(8):1181-6.
Detmar SB, Muller MJ, Schornagel JH, Wever LD, Aaronson NK. Health-related quality-of-life assessments and patient-physician communication: a randomized controlled trial. J Am Med Assoc. 2002;288(23):3027-34.
Hess R, Tindle H, Conroy MB, et al. A randomized controlled pilot trial of the Functional Assessment Screening Tablet to engage patients at the point of care. JGIM. 2014; 29(12):1641-1649.
Velikova G, Brown JM, Smith AB, Selby PJ. Computer-based quality of life questionnaires may contribute to doctor-patient interactions in oncology. Br J Cancer. 2002;86(1):51-9.
Velikova G, Booth L, Smith AB, et al. Measuring quality of life in routine oncologypractice improves communication and patient well-being: a randomized controlled trial. JClin Oncol. 2004;22(4):714-24.
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Questions?
Contact Information:[email protected] (310-794-2294)
Powerpoint file posted at: http://hpm214.med.ucla.edu/