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).

Discussion Leader: Donald Patrick PhD, MSPH, Professor, University of Washington, Seattle, WA, USA

Discussants:
Edward Sondik PhD, Director, National Center for Health Statistics, Center for Disease Control, Hyattsville, MD, USA (invited)
Dean Jamison PhD, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA (invited)
Joshua Salomon PhD, Evidence and Information for Policy World Health Organization, Geneva, Switzerland
Joan Rovira PhD, Senior Health Economist-Pharmaceuticals, World Bank, Washington, DC, USA
David Moriarity, Program Analyst, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA

• 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.

Discussion Leader: William Lawrence, MD, MS, Center for Outcomes and Effectiveness Research, AHRQ, Rockville, Maryland, USA

Discussants:
Sepheen C. Byron MHS, Research Analyst, Agency for Healthcare Research & Quality, Rockville, MD, USA
Tessa Tan-Torres PhD, Coordinator, World Health Organization, Geneva, Switzerland
Jon Clouse RPh, MS, Executive Vice President, Ingenix Services, Eden Prairie, MN, USA

• 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.
• To what extent will we maximize quality of life if we attempt to maximize health status?
• 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?

Discussion Leader: Paul Kind Mphil, Senior Research Fellow, University of York, York, UK

Discussants:
Robert Blendon ScD, Professor, Harvard School of Public Health & Policy Analysis, Boston, MA, USA (invited)
Joshua Salomon PhD, Evidence and Information for Policy World Health Organization, Geneva, Switzerland
George Torrance PhD, Professor Emeritus, McMaster University, Burlington ON, Canada
Donald Patrick PhD, MSPH, Professor, University of Washington, Seattle, WA, USA

• 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.

Discussion Leader: Pennifer Erickson PhD, Co-Founder, O.L.G.A, State College, PA, USA

Discussants:
Michael Wolfson, Assistant Chief Statistician, Analysis and Development, Statistics Canada, Ottawa, Ontario
Joseph Lipscomb PhD, Chief, NCI, ARP, ORB, National Cancer Institute, National Institute of Health, Bethesda, MD, USA

• 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?