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Summary
Measures of Population Health: A Working Group Meeting
AGENDA
9 am – 5 pm, Saturday, May 17, 2003
Marriott Crystal Gateway, Arlington, Virginia
INTRODUCTION:
Health Outcomes Framework
Overview of health status and quality of life measures from the macro to
micro level. Rationale for vertical integration of core data components in
order to link data captured on the micro level (for example, clinical trial)
to data developed on the macro level (population health measures).
SESSION I: Agency-specific rationales
for developing summary measures of population health?
How will the information be used? (1) From the decision-makers’ perspective,
how does the collection and use of health status / QoL measures and resulting
summary metrics differ from the traditional measures of morbidity, mortality,
disease incidence / prevalence, etc? (2) What specific needs do the ‘new’
summary metrics address? What is the mandate for the measurement of
population health within each agency? Where does the direction come from? Who
will use these measures? If they will be used for health policy
decision-making or allocation of resources, who will make these decisions and
whose resources will be allocated on the basis of these measures? How much
input do these decision-makers have into the design and collection of your
measures?
SESSION I:
DISCUSSION
The following issues will be discussed:
- Do agencies have similar missions? How do
their missions differ?
- Do agencies have different perspectives?
Different focus?
- To what extent will a measure that serves,
say NCHS, satisfy or not satisfy the WHO’s mission?
- Will differences in missions / goals be
reflected in different measures / different methods?
SESSION II:
How do the agencies’ missions and uses of population health relate
to strategies for measuring health status and quality of life?
It is envisioned that this session will discuss rationales for choosing among
alternative measurement strategies and implications of the choice for policy
making. Discussions will address: (1) the need to allocate resources fairly
and efficiently; past and present efforts to develop a metric for maximizing
value (costs, counts, life years, healthy life years, QALYs, DALYs); (2) the
link between health measures and allocation of government resources,
including a discussion on political realities and lobby / advocacy groups;
(3) the potential role for ISPOR’s initiative on bridging the gap between
data and policy-makers; similarities with formularies, reimbursement boards,
etc.; and (4) the issues involved in developing measures that are useful for
decision-makers.
SESSION II: DISCUSSION
The following issues will be discussed:
o What type of interaction is needed between the research and policy
community so that information from a full range of measures is understood and
properly interpreted. How can we facilitate this interaction and appropriate
data collection.
o To what extent will we maximize quality of life if we attempt to maximize
health status?
o What is the obligation of society to provide for quality of life of its
members?
SESSION III: What efforts have been
made to obtain societal values regarding allocation of resources and
inclusion of their perspectives into design and use of health status
measures?
Are we measuring something that may not be a major concern of ‘society’? For
example, when asked, the majority of members of most societies have supported
the ‘rule of rescue’ and equity over efficiency. Have any of these feelings
been ascertained and how are the findings incorporated into the measurements,
if at all? What lessons can we draw from the Oregon Experiment? What do we
know about what “society” wants from health care? How can we better
understand “society’s” perspectives?
SESSION III: DISCUSSION
The following issues will be discussed:
- Are we focusing too narrowly? Are there
alternative models for constructing summary population health measures?
- How do the current methods relate to these
concerns?
- How well do current measures of population
health address equity issues? How well do they suggest means to use health
care funds efficiently?
- Do we need more than one set of
preferences? What is to be gained from having preferences for different
sociodemographic groups?
SESSION IV:
Current and Emergent Measures and Interpretation: Return to Health Outcomes
Framework.
Approaches for implementing a coordinated approach to population health
assessment, including ideas for expanding analytic methods and data
collection activities to support meaningful analyses and interpretations
across the various research approaches will be suggested. These proposals
will draw on current applications that may range from clinical research to
population health.
SESSION IV: DISCUSSION
The following issues will be discussed:
- Can we formulate a strategy for obtaining
health state valuations from both broad and diverse general populations and
more restricted disease populations that present consistent and appropriate
measures for societal level decisions?
- To what extent does the need for
self-report relate to the goal and anticipated use of the measure? To what
extent can / should clinical or outcomes (non-self-report) versus
self-report be used? What about individuals who cannot provide a response,
i.e., children?
- Quality-adjusted life year measures have
been reported on in experimental settings for over 30 years. Although the
concept of adjusting life expectancy for quality of life has been widely
embraced, why have QALYs themselves not widely adopted for population
monitoring and large-scale resource allocation? What measurement issues
remain?
- Are there plans to develop generalized cost
effectiveness analyses? Is this practical? Should productivity gains be
considered in measuring health?
CONCLUSIONS AND NEXT STEPS
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