HealthPros has 13 Fellows.

Below you will find a short description of each (PhD) research project.

ESR 1- Erica Barbazza, MSc, BHSc

Transferability of actionable performance indicators: Making performance indicators work

Host:

Prof. Dr. Niek Klazinga / Dr. Dionne Kringos

Academic Medical Centre of the University of Amsterdam

Department of Public Health

Amsterdam, The Netherlands

www.amc.nl

Duration: 48 months

Erica will develop state of the art methods to enhance fitness for use of healthcare performance indicators for different purposes.

Background

Insight into the performance of a healthcare system as a whole or specific parts, such as the primary care system, requires scientifically sound conceptual frameworks (e.g. the Dutch Healthcare Performance Report by the RIVM or the Canadian Health System Performance framework by CIHI). The use of indicators populating these frameworks depends on their practical use and relevance to resolve contemporary health policy challenges. Good-quality studies are needed to improve the balance of current indicator sets to optimize use and realization of impact. Recent studies found that quality indicators on patient safety, medication prescribing, mental healthcare and patient experiences are reported least often in national performance frameworks. Similarly, it is advocated to develop (patient reported) outcome measures relevant to patients, clinicians, system managers and policy makers. Factors potentially hampering the shift from performance measurement towards performance management include the administrative burden and overall costs, data linkage problems, privacy issues, and a lack of skills to translate healthcare services data into actionable knowledge. Apart from reliability and validity, actionability is a crucial component for indicators to make them work.

Approach 

The PhD candidate will identify the characteristics of healthcare performance indicators used in Europe and Canada as well as the conditions in which they are used (e.g. specific purposes for healthcare performance measurement) and factors that are likely to contribute to their actionability and the extent this has led to measurable results for balancing between improving the health of populations, delivering quality care for individuals, and containing costs. Hence emphasis lies on the (international) transferability of actionable indicators for various purposes as part of health system performance.

 

ESR 2- Yuanhang Yang, MSc

Quality of health care for vulnerable populations: Are We Closing Disparity Gaps?

Host:

Prof. J. Mainz / Prof. S.P. Johnsen

Centre of Clinical Health Services Research

Aalborg Psychiatric Hospital – Aalborg University Hospital

Denmark

Duration: 36 months

Yuanhang will 1) Develop and evaluate methods for monitoring changes over time of disparities in quality of health care for vulnerable populations, identified according to age, gender, socioeconomic status, ethnicity and comorbidity burden. 2) Implement the measures in clinical practice.

Background

Insight into the performance of a healthcare system requires scientifically sound conceptual frameworks (e.g. the Dutch Healthcare Performance Report by the RIVM or the Canadian Health System Performance framework by CIHI). The use of these frameworks depends on their relevance to resolve contemporary health policy challenges. Health care for vulnerable groups is such a challenge. At present, specific indicators on the performance of health care services and systems with respect to vulnerable groups, are often lacking in performance schemes. This project tries to fill this void.

Approach 

The PhD candidate will apply clinical epidemiology methods, biostatistics and data management to combine and blend new approaches that suit local requirement for health care performance management in the performance areas equity in access and reaching better outcomes. He/she will prioritize disparities in quality of healthcare services for vulnerable patients according to age, gender, socioeconomic status, ethnicity and comorbidity burden to be directly linked with the Danish National Quality Improvement. He/she will identify the local barriers and solutions to monitor the measure overtime and to implement this directly in clinical practice. Novel regional practices established in Italy with the performance evaluation dashboard will contribute to sharpen regional measurements in Denmark. The researcher will test the -in Denmark- developed and validated composite measures in the Italian regional healthcare system. Qualitative and quantitative data will be used from Danish health care registries, that can be linked unambiguously using the unique 10-digit civil registration number, which all Danish citizens receive upon birth or immigration.

 

ESR 3- Pinar Kara, MSc

Composite measures for quality of health care for patients with chronic conditions: are we comparing apples and pears?

Host:

Prof. J. Mainz / Prof. S.P. Johnsen

Centre of Clinical Health Services Research

Aalborg Psychiatric Hospital – Aalborg University Hospital

Denmark

Duration: 36 months

Pinar will: 1) Develop and evaluate composite measures for quality of care of patients with stroke, heart failure and chronic obstructive lung disease. 2) Implement selected composite measures in clinical practice.

Background

Insight into the performance of a healthcare system requires scientifically sound conceptual frameworks (e.g. the Dutch Healthcare Performance Report by the RIVM or the Canadian Health System Performance framework by CIHI). The use of these frameworks depends on their use and relevance to resolve contemporary health policy challenges. Frameworks are often populated with large amounts of indicators and policy makers are asking for smaller numbers of composite measures that are valid and reliable to support their decision making. The project will focus on the validity, reliability and actionability of compound indicators on the quality of health care for patients with chronic conditions.

Approach 

The PhD candidate will develop and evaluate composite measures of the quality of care for patients with stroke, heart failure and chronic obstructive lung disease, and implement selected composite measures for clinical quality improvement to reach better outcomes for chronically ill patients. Different composite measures of quality of care will be computed and the effect of using different composite measures on hospital rankings will be determined. Qualitative and quantitative data will be used from Danish health care registries, that can be linked unambiguously using the unique 10-digit civil registration number, which all Danish citizens receive upon birth or immigration. The researcher will test the -in Denmark- developed and validated composite measures in the Italian regional healthcare system.

 ESR 4- vacancy

Optimising the use of routine health databases for personalised risk profiling stimulating patient engagement

Host:

Prof Simon de Lusignan/Prof. Fabrizio Carinci

University of Surrey

Guildford, UK

Duration: 36 months

The studies will explore feasibility and expandability of a risk profiling model using data available from the existing national databases for improved person-centred care and direct patient activation. The results will help identifying the optimal data granularity required to exchange information and use the method in a valid and secure way internationally.

Background

Person-centred care implies making the right decisions using the best available evidence in the context of the individual subject. Modern health care is reshaping the role of the physician at the crossroads of a complex framework of rapid technological development and higher expectations of individuals, but multiple sources do not necessarily translate into effective decisions. Risk profiling can help both the physician and the patient agreeing informed directions and trigger the right processes for patient-centred care. The use of routine health databases, albeit promising, has been relatively limited in real world conditions.

This project will allow identifying new standards for risk profiling, using large scale clinical databases to take into account different populations within and across countries for potential everyday use.

Approach

A series of studies will investigate the potential of large routine health databases for different types of personalised risk profiling of patients to be used routinely for shared-decision making in a clinical setting. Risk profile algorithms will build on statistical models taking into account multiple characteristics collected from the existing databases, including clinical parameters (e.g. vascular complications of lower extremities in diabetes), behavioral factors (e.g. compliance to treatment and patient activation) and socioeconomic conditions. The PhD candidate will benefit from direct access to relevant databases managed by established networks e.g. the RCGP database, the nationwide Scottish database (SCI-FI), the Danish quality registries and diabetes-related data sources managed by centres of the EUBIROD network and OptiMedis.

 

ESR 5- Nicolas Larrain, MBA, MSc

Measuring and improving the performance of integrated health care systems

Host:

Dr Oliver Groene

OptiMedis AG, Hamburg

Germany

www.optimedis.com

Duration: 36 months

Nicolas will develop novel approaches to health system performance assessment, focusing on Triple-Aim based integrated care delivery systems

Background

Health systems around the globe are introducing reforms to reduce fragmented care delivery systems which result in inefficiencies and suboptimal patient outcomes. Integrated care delivery systems are networks in which provider organizations such as general practitioners, specialist, nursing, hospital and long-term care institutions work together to achieve the Triple Aim (Berwick et all 2008). In order to achieve this aim, integrated care delivery systems need a much better understanding of current and future drivers of, and need to identify the interventions best suited to improve population health.

Various conceptual models of health system performance and population health exist, but their practical application is limited. This is first because of insufficient access to and exploitation of the wide range of data sources required to assess population health. Second, implementation sciences suggests that contextual factors need to be taken into consideration to maximize the real world impact of interventions that have shown to be effective in the literature (Groene 2011).

Approach 

The PhD candidate will develop novel approaches of performance assessment in Triple Aim-based integrated health care systems using a wide range of data sources including patient and staff surveys, routine health insurance data, GP practice record extracts and geo-tagged data. Based on these data sources the PhD candidate will design statistical models to gauge the impact of promising population health interventions.

 

ESR 6- Kendall Jamieson Gilmore, MSc

The role of managerial systems in promoting integrated care pathways

Host:

Prof. Sabina Nuti / Dr. Anna Maria Murante

Scuola Superiore Sant’Anna

Istituto di Management, Laboratorio Management e Sanità

Pisa, Italy

www.santannapisa.it

Duration: 36 months

Kendall will work on managerial strategies and tools to boost professional networks to be accountable for the outcomes and results of their patients. 

Background

The use of performance measurement and scientific evidence to steer value for money has become a priority for all governments. In the healthcare sector, value is delivered to patients through the collaboration of multiple organizations. Current performance measurement systems (PMSs) are mainly designed to measure financial sustainability and performance at the individual service level and therefore lack in assessing the value delivered to patients at the system level. The HealthPros Network aims suggest the introduction of new PMSs that allow healthcare policy makers and other stakeholders to assess the performance of horizontal networks of care providers according to a patient-based perspective. Building on the existing expertise with service-based and population-based performance measurement this project will develop managerial systems focusing on integrated care pathways.

Approach 

Patient experience and outcomes should be the starting point to achieve high quality care. Consequently, healthcare performance evaluation systems, driving change in line with this main strategic goal, should be designed. At present most performance evaluation schemes take a specific service and/or the providers view as their focus. . Consequently, they reproduce a ‘silo-vision’ characterized by a responsibilities’ divide and limitation to a specific setting of care or to a single organization. The PhD candidate will work on solutions that approach the use of patient reported measures together with indicators based on administrative data, in order to evaluate cross-setting healthcare services through a healthcare multidimensional performance evaluation system. Moreover, the PhD candidate will be involved in designing specific policies (such as bundled payments) to create a common accountability system able to increase shared responsibilities regarding complex patients’ outcomes and tackling ineffective health spending and waste.

 

ESR 7- Damir Ivankovic, MD, MBA

Results-based (corporate) governance-tools for healthcare

Host:

Prof. Dr. Niek Klazinga / Dr. Dionne Kringos

Academic Medical Centre of the University of Amsterdam

Department of Public Health

Amsterdam, The Netherlands

www.amc.nl

Duration: 48 months

Damir will develop results-based management tools originating from the private sector tailored to the needs of healthcare policy and management.

Background

Results-based management tools such as for example balanced score cards, are commonly used in the corporate sector to improve results by monitoring performance, learning, adapting and target setting. Such tools may be useful in healthcare management as well. However, since healthcare differs essentially from goods produced in the corporate sector, existence of dynamic policy environments and strong stakeholder influence, existing tools from the corporate sector cannot simply be transferred to the health care area but need to be tailored to the specific needs of the health care environment and its services.

Approach 

The PhD candidate will use mixed methods. Surveys and interviews in the Netherlands and Ontario will be performed to examine whether recently introduced results-based (corporate) governance tools approaches to performance measurement have persisted, been used by policy-makers and healthcare providers, and resulted in changes in policy and funding decisions. The local application of national performance data will be analyzed. Together with public sector HealthPros partners in Canada, Italy and in the Netherlands, the PhD candidate will test results-based management tools used in the private sector for their validity in the health care sector and for policy making.

ESR 8- Óscar Brito Fernandes, M.Sc., M.Ed.

Patient engagement in healthcare purchasing by insurers: Reducing waste, increasing value

Host:

Prof. Dr. László Gulácsi/ Dr. Petra Baji

Corvinus University of Budapest

Budapest, Hungary

hecon.uni-corvinus.hu

Duration: 36 months

Óscar will develop a business model for engaging patients in insurer purchasing decisions and applying performance intelligence in contract arrangements between health care insurers and providers.

Background

To maximize value for money spent on health care services and to assure patient engagement in integrated service provision, there is an increasing need to integrate consumer preferences and performance intelligence into health services by contracting and applying performance intelligence for health financing. Good quality studies are necessary to reveal how performance indicators can be used to elicit consumer preferences (with special attention for vulnerable populations) regarding health service attributes as well as to examine how patients can be involved in the financial decision making of health insurance funds (e.g. contracting and accounting) to increase value for money for consumers and society and assure patient engagement in integrated service provision.

Approach 

The PhD candidate will develop a business model for effectively involving patients in the financial decision making of health insurance funds, a survey tool on preferences of consumers regarding quality attributes of health care services, and a framework based on best practices how these results can be used as inputs for decision making of financing providers and services and as well as investment priorities.

 

ESR 9 Armin Lucevic, MSc

Building performance intelligence in contract arrangements between insurers and health care providers

Host:

Prof. Dr. László Gulácsi/ Dr. Petra Baji

Corvinus University of Budapest

Budapest, Hungary

hecon.uni-corvinus.hu

Duration: 36 months

Armin will study how performance indicators can be used in financing health care services to promote the integrated service delivery approach and help payers to create incentive structures for providers to ensure the use of services which provide better value for money in terms of clinical effectiveness, patient safety and patientcenteredness, and to reduce ineffective health spending and waste.

Background

Performance indicators can be used in financing health care services to promote a integrated service delivery approach and help payers to create incentive structures for providers to ensure access, optimal use of services and equity to provide better value for money in terms of clinical effectiveness, patient safety and patientcenteredness, and to reduce ineffective health spending and waste. Thus, good quality research is neccesary to provide better insight in best practices for linking financial incentives to healthcare performance at individual health care provider-, institutional- and regional level, as well as to model the economic consequences (costs and benefits) of different performance indicator improvement scenarios.

Approach 

The PhD candidate will examine how to link performance indicators to payment mechanisms and contracting, evaluate available insurance databases whether these are suitable to link performance indicators to financial mechanisms and identify the potential for transferability of experiences between health care systems. 

 

ESR 10-Sophie Wang, MSc

Improving the uptake of performance reports via nudges

Host:

Dr Oliver Groene

OptiMedis AG, Hamburg

Germany

www.optimedis.com

Duration: 36 months

Sophie will investigate how physician-behavior can be ´nudged´ via reports on their performance in an integrated care delivery system

Background

This project will make an important contribution to the ongoing development and implementation of performance reports that are designed for providers with a view to stimulate performance improvement (Brehaut et al 2016). The results will lead to an important conceptual advancement of improving the use of health care performance data and to specific recommendations how nudges can be integrated into existing performance reports (Thaler & Sunstein 2008). This research project will examine the uptake of performance reports by healthcare providers via nudges applying a novel, cutting edge behavioural economics approach (Voyer B 2015).

Approach 

The PhD candidate will investigate the impact of a range of nudges for different performance domains (but with a focus on the clinical effectiveness domain) and on metrics that not only refer to composite outcomes, but to the distribution of such outcomes in a population (e.g. equity in access, utilisation and outcomes), a unique perspective widely disregarded by current performance reports. The PhD candidate will produce various performance report cards using the range of data sources available to OptiMedis AG and will design experiments that test how different nudges can foster innovation in clinical and health services management.

 

ESR 11-Bernardo Meza-Torres MSc.

The impact of automated international comparisons using routine large scale databases to improve diabetes care

Host:

Prof Simon de Lusignan/Prof. Fabrizio Carinci

University of Surrey

Guildford, UK

Duration: 36 months

Bernardo will design and apply a common method to pool relevant data from existing national clinical databases. Specific applications will address research questions comparing quality of care and outcomes within and across countries, with the highest standards of privacy protection. The model will be generally applicable to a range of performance evaluation studies.

Background

The provision of high value care require sharing evidence-based information among a diverse group of stakeholders, including providers, policy makers and citizens. Performance benchmarking has been increasingly advocated as a key strategy for continuous improvement, but is still hampered by limited access to high quality information. In particular, clinical characteristics remain still difficult to use in combination with the most common process measures, due to the lack of structured models for secure data integration. In such scenario, international comparisons appear weak and hard to interpret. This project will allow identifying new standards for the automated production of health care quality indicators in Europe, using diabetes as a test bed application.

Approach

A series of studies will examine the effect of targeted interventions (e.g. smoking cessation, glycaemic control, vascular risk management, foot care, vascular surgery) and different organizational arrangements (improved adherence, reduction of vascular risk, frequency of visits, integration of primary/specialist care, minor amputations, continuity of care, etc) on diabetes-related outcomes. Selected primary endpoints will be adopted to derive actionable conclusions for policy (e.g. peripheral arterial disease and major lower amputations).

The PhD candidate will exploit the potential of world class national databases through the direct access to established networks e.g. the RCGP database, the nationwide Scottish database (SCI-FI), the Danish quality registries, diabetes-related data sources at centres of the EUBIROD network and OptiMedis.

 

ESR 12- Claire Wilmington, MSc

Reputation counts: putting health care benchmarking at work

Host:

Prof. Sabina Nuti / Dr. Anna Maria Murante

Scuola Superiore Sant’Anna

Istituto di Management, Laboratorio Management e Sanità

Pisa, Italy

www.santannapisa.it

Duration: 24 months

Background

To improve the actual use of performance intelligence by the different end-users it is relevant to study and analyse how  performance evaluation systems and tools are able to stimulate changes in organizational behaviour at regional and local level, also by considering the different stakeholders involved in the health care system (policymakers, health professionals, patients and users). How performance evaluation systems should be designed and used to have impact, in particular with respect to professional engagement, is the main topic of this research project.

Approach 

Claire will: 1) Advance the scientific knowledge on how benchmarking can support policy making, defining challenging targets; 2) implement tools able to track unwarranted geographical variation to enhance the equity in access and treatment; 3) work on the promotion of tools able to identify priorities based on benchmarking, trends and avoidable variation; 4) work on the use of PROMS and PREMS in the target-setting phase from a clinical path-way perspective; 5) perform analysis to measure room for disinvestment and opportunity for resource reallocation; 6) design reward systems able to motivate different stakeholders: health managers, professionals and patients 7) study factors that make a difference in clinicians motivation and engagement.

ESR 13- Mircha Poldrugovac, MSc, MD

Effective use of performance reporting in long-term care

Host:

Prof. Dr. Niek Klazinga / Dr. Dionne Kringos

Academic Medical Centre of the University of Amsterdam

Department of Public Health

Amsterdam, The Netherlands

www.amc.nl

Duration: 48 months

Mircha will optimize the effective use of performance reporting in Long-Term Care Sector. The project will result in improved adequacy of performance outcome measures and insight in perceptions of the importance of performance data in long-term care homes and its association with different organizational characteristics. It will provide insight into whether organizational responses to performance data are related to competitiveness in the marketplace and the for-profit status of the organization; and identify which domains of performance reporting are likely to trigger the greatest increase in quality improvement activity.

Background

Contrary to the hospital care sector, there is much less of a strong tradition of performance measurement and reporting in the long-term care sector. Given the growing importance of this sector, it is of paramount importance that appropriate measures of the technical quality of long-term care for patients, caregivers and decision-makers are developed, and are reported on and applied in an effective manner to stimulate quality improvement of the long-term care sector. Lessons can be learnt from countries that are frontrunners in performance reporting in long-term care, such as Canada.

Approach 

The PhD candidate will identify the policy and organizational characteristics associated with the use of performance reports in the long-term care sector in Canada and to infer lessons for European countries through an international comparison with the Netherlands, Italy and other selected European countries. It will be determined whether organizational responses to performance reporting vary with for profit status, the performance domains reported, and the degree of competition for patients. Methods will include interview and case study data. The PhD candidate will consider which domains of performance reporting are likely to trigger the greatest increase in quality improvement activity. Surveys and interviews in a range of long-term care homes will be matched to document analysis and analysis of routinely collected data in several jurisdictions, benefiting from available data at HealthPros partner organisations.