Evaluation Of Health Care Interventions Research Articles

Economic Evaluations of Health Care Interventions in Pediatric Hospital Care.

The hospital medicine movement thrives in a health care environment committed to providing high-quality, safe, and value-based care. Hospitalists and hospitals continually grapple with many decisions regarding adopting new interventions and deadopting established ones. These decisions span the gamut from tests, treatments, and supportive care, to care models. Traditionally, the choice to adopt one intervention over another is commonly thought of in terms of its direct impact on patient outcomes, benefits, and harms. However, the evolving landscape of health care, characterized by increasing constraints on resources necessitates a broader perspective, one that includes a thorough consideration of the economic implications. The goal is not to minimize costs but rather to maximize value, outcomes achieved for money spent. Economic evaluations of health care interventions can provide this information by quantifying value and assisting health care providers, hospitals, and health systems in deciding which intervention to adopt. Economic evaluations deal with both inputs (ie, costs) and outputs (ie, consequences). Few economic evaluations in pediatric hospital medicine have been published, and many clinicians are unfamiliar with them. This paper discusses the economic evaluation of health care interventions with special attention to the pediatric hospitalist and hospital care. The paper aims to give readers an understanding of the key concepts underlying economic evaluations.

The impact of a nurse's dual role on implementing an effectiveness study.

Reorganizing the Approach to Diabetes through the Application of Registries (RADAR) improved diabetes care and outcomes for First Nations people in Alberta, Canada. The nurse involved in the implementation of RADAR performed two roles in this model of care: research nurse and care coordinator. To describe the research nurse's dual role in the implementation and evaluation of RADAR. The research nurse not only documented and collected data in hard-to-reach communities as part of effective research, she also provided remote care coordination to support community healthcare providers using a culturally tailored registry to facilitate population-level care. This dual role required many qualities of nursing leadership and transformation. The research nurse's two roles contributed to the success of the intervention and were critical to the successful implementation of the model, creating valuable real-world evidence across diverse populations and settings. for practice Nurses are well placed to perform research duties alongside engagement and implementation activities. This can enhance the effectiveness and evaluation of healthcare interventions, particularly in community-based interventions within First Nations communities.

Adopting a stance of vulnerability in healthcare evaluation: Amplifying the patient voice.

This paper argues that one aspect of re-imagining evaluation in health planning and management is for leaders and clinicians to develop comfort with vulnerability when engaging in service evaluations. Starting with an exploration of how the service user voice is traditionally expressed in healthcare evaluation, the paper then proceeds to explore the particular role and challenges faced by clinician-evaluators, including their role as 'privileged interlocutors' in conversations with service users. The tensions in reconciling the role of the clinician as an expert, with the related but different skills needed for effective discourse in qualitative evaluation are explored, and it is asserted that it is important for clinicians and leaders to be comfortable in showing and working with vulnerability when evaluating healthcare interventions. Clinicians are already skilled in holding discourse with service users, and extending the communication repertoire to include the management of emotion and expression of vulnerability is achievable and rewarding. The paper concludes that the ability to hold a vulnerable stance when conducting evaluation can have benefits in reducing defensiveness, encouraging a truer sense of enquiry and amplifying the service user voice.

A structured process for the validation of a decision-analytic model: application to a cost-effectiveness model for risk-stratified national breast screening.

Decision-makers require knowledge of the strengths and weaknesses of decision-analytic models used to evaluate healthcare interventions to be able to confidently use the results of such models to inform policy. A number of aspects of model validity have previously been described, but no systematic approach to assessing the validity of a model has been proposed. This study aimed to consolidate the different aspects of model validity into a step-by-step approach to assessing the strengths and weaknesses of a decision-analytic model. A pre-defined set of steps were used to conduct the validation process of an exemplar early decision-analytic-model-based cost-effectiveness analysis of a risk-stratified national breast cancer screening programme [UK healthcare perspective; lifetime horizon; costs (£; 2021)]. Internal validation was assessed in terms of descriptive validity, technical validity and face validity. External validation was assessed in terms of operational validation, convergent validity (or corroboration) and predictive validity. The results outline the findings of each step of internal and external validation of the early decision-analytic-model and present the validated model (called 'MANC-RISK-SCREEN'). The positive aspects in terms of meeting internal validation requirements are shown together with the remaining limitations of MANC-RISK-SCREEN. Following a transparent and structured validation process, MANC-RISK-SCREEN has been shown to have satisfactory internal and external validity for use in informing resource allocation decision-making. We suggest that MANC-RISK-SCREEN can be used to assess the cost-effectiveness of exemplars of risk-stratified national breast cancer screening programmes (NBSP) from the UK perspective. A step-by-step process for conducting the validation of a decision-analytic model was developed for future use by health economists. Using this approach may help researchers to fully demonstrate the strengths and limitations of their model to decision-makers.

Estimating and Rewarding the Value of Healthcare Interventions Beyond the Healthcare Sector: A Conceptual Framework.

Evaluating healthcare interventions for their impacts beyond health outcomes may result in recognition of changes in human capital, income level, tax revenue, and government spending, which could affect economic growth and population health. In this paper, we document instances where current health technology assessment (HTA) practices fail to account for the impacts of healthcare interventions on broader society beyond the healthcare sector. We propose a novel conceptual framework, highlighting its three components (distributional cost-effectiveness analysis [DCEA], input-output model, and voting scheme) and their contributions to capturing the economic and societal ripple effects of healthcare interventions. This manuscript also outlines a case study in which the framework is applied to the reassessment of a previously evaluated digital health therapeutic for the treatment of opioid use disorder (OUD) compared with standard of care, demonstrating its practical application. The DCEA health value metric indicates that digital therapeutic is more equitable, favoring socioeconomically disadvantaged groups, while standard of care exacerbates health inequality by benefiting the already advantaged. Additionally, digital therapeutic shows potential for boosting productivity, raising income, and creating jobs, supporting its consideration by employer-sponsored health plans to optimize resource allocation for treating OUD. The conceptual framework provides insights for enhancing HTAs to incorporate the broader economic and societal impacts of healthcare interventions. By integrating DCEA, extended HTA analysis with input-output modeling, and a voting scheme, decision makers can make informed choices aligned with societal priorities, although further research and validation are necessary for practical implementation across diverse healthcare contexts.

Quality- and productivity-adjusted life years: From QALYs to PALYs and beyond

We develop a unified framework for the measurement and valuation of health and productivity. Within this framework, we characterize evaluation functions allowing for compromises between the classical quality-adjusted life years (QALYs) and its polar productivity-adjusted life years (PALYs). Our framework and characterization results provide a new normative basis for the economic evaluation of health care interventions, as well as occupational health and safety policies, aimed to impact both health and productivity of individuals.

Analysis of the Correlation between Physical Activity, Nutritional Status, and Learning Achievement with the Health Quality of Adolescents Life in East Bolaang Mongondow Regency

Quality of life is one of the criteria currently used to evaluate healthcare interventions. The aim of this study is to assess the relationship between physical activity, nutritional status, and academic performance with the health-related quality of life of adolescents in East Bolaang Mongondow Regency. This research is a correlational study with a cross-sectional approach conducted in junior high schools and high schools in East Bolaang Mongondow Regency in October 2023, with a total sample size of 430. The instrument used in this study is a questionnaire, and the data were analyzed using univariate and bivariate analysis with the Chi-Square test. The results of the study showed that the variable of physical activity had a p-value < 0.05 in the domains of physical health (p=0.000), psychological health (p=0.000), and environment (p=0.000). However, for the social relationships domain, the p-value was > 0.05 (p=0.100). The variable of nutritional status had a p-value < 0.05 in the domains of physical health (p=0.000), psychological health (p=0.002), social relationships (p=0.000), and environment (p=0.000). The academic performance variable had a p-value > 0.05 for all domains. The conclusion of this study is that physical activity is associated with the quality of life in the domains of physical health, psychological health, and environment. Nutritional status is associated with all domains of quality of life, while academic performance is not associated with the quality of life in any domain.

How do pilot and feasibility studies inform randomised placebo-controlled trials in surgery? A systematic review

IntroductionRandomised controlled trials (RCTs) with a placebo comparator are considered the gold standard study design when evaluating healthcare interventions. These are challenging to design and deliver in surgery. Guidance recommends...

Quantifying the causal impact of biological risk factors on healthcare costs

Understanding the causal impact that clinical risk factors have on healthcare-related costs is critical to evaluate healthcare interventions. Here, we used a genetically-informed design, Mendelian Randomization (MR), to infer the causal impact of 15 risk factors on annual total healthcare costs. We calculated healthcare costs for 373,160 participants from the FinnGen Study and replicated our results in 323,774 individuals from the United Kingdom and Netherlands. Robust causal effects were observed for waist circumference (WC), adult body mass index, and systolic blood pressure, in which a standard deviation increase corresponded to 22.78% [95% CI: 18.75-26.95], 13.64% [10.26-17.12], and 13.08% [8.84-17.48] increased healthcare costs, respectively. A lack of causal effects was observed for certain clinically relevant biomarkers, such as albumin, C-reactive protein, and vitamin D. Our results indicated that increased WC is a major contributor to annual total healthcare costs and more attention may be given to WC screening, surveillance, and mitigation.

Leveraging patient experience measures as surrogate outcomes to evaluate health care interventions

Leveraging patient experience measures as surrogate outcomes to evaluate health care interventions

#6055 PATIENT REPORTED OUTCOMES AMONG DIALYSIS POPULATION IN STATE OF QATAR

Abstract Background Patients with (ESKD) undergoing dialysis, experience large burden of the disease and suffer variable symptoms that impact their health-related quality of life (HRQL). However, their symptoms are often under-recognized and under treated by their health care providers because they depend on objective measures such as physical examination and lab results. These examinations mostly don't reflect patients’ symptoms and the impact on health-related quality of life. Therefore, standardized subjective measures are important for symptoms screening and may improve symptom detection and treatment. Patient-Reported Outcome Measures (PROMs) are example of these measures and it capture patients’ symptom burden, level of functioning, and HRQL. PROMs can be used to evaluate and monitor aspects of patients’ health that may otherwise be overlooked, inform care planning, and facilitate the introduction of treatments. Aims To capture patients perceptions of their health and to address the HRQL symptoms in haemodialysis,to capture patients perception of their health and address the HRQL symptoms in chronic haemodialysis patients. To find the tools for follow up those HRQL symptoms. To encourage and promote patients patriation in care plan. Method Sample of 94 haemodialysis patients were included. We used two validated questionnaires to assess patients reported outcome (IPOS & EQ-5D) because there is no single instrument has established itself as the gold standard for measuring patient status. The (IPOS) captures symptoms such as, diarrhea, changes in skin color, restlessness, difficulty to sleep,itching,poor mobility, drowsiness, mouth sore, constipation, poor appetite,vomiting,nausea,weakness and renal scale. The (EQ-5D) is a standardized measure of health-related quality of life from five dimensions (Mobility, self-care, usual activities, pain, depression and anxiety). Results Majority of participants in this survey were male (n = 56; 60%). Middle eastern (67%), between the age of 19 to 77 (Mean = 53; STD =14). In the IPOS 50% of the patients reported the presence of symptoms such as difficulty of sleeping, itching, poor mobility, and general weakness. However, the severity of these symptoms varied from zero severity to overwhelming, 16% of patients were bothered by severe difficulties to sleep and poor mobility,15% had severe lack of energy,13% severe shortness of breath and 11% reported poor appetite. Pain was reported by 44% of patients out of which 33% expressed it as slight to moderate and 11% reported severe pain. The EQ-5D revealed that 47% have problem in walking, 41% of patients found to have difficulties in performing their usual activities, 27% of patients expressed feelings of depression and anxiety (22% mild to moderate and 5% severe).In addition 17% reported difficulties to perform self-care activities such as washing and dressing themselves. Conclusion Patients reported outcome is an important approach that captures patients’ perspectives of health and disease. PROM could result in improvement of health care delivery because it is a way to evaluate health care interventions effectiveness in a reliable and acceptable way that value patient's feedback. clinicians can utilize treatment aids to manage symptoms. Treatment aids are actionable assessment and treatment resources developed by expert clinicians and patient partners for the management of certain symptoms using these aids will help in tailoring patients therapy to improve outcome. And patients physician communication and improve quality performance.

Considering the best study designs to evaluate healthcare interventions

Considering the best study designs to evaluate healthcare interventions

MSR139 Safe to Assume? Unpacking Regression Assumptions for Utility Data

Health-related quality-of-life, often reported as utility scores, is an important endpoint in the evaluation of healthcare interventions. Yet the analysis of utility data is complicated by its distributional properties, which raise numerous statistical challenges. As there is no consensus on the most appropriate regression for analyzing utility data, the aim of this paper was to develop a framework to evaluate common regression methods.

OP79 Incorporating Environmental Impacts Into Health Technology Assessment: An Examination Of Potential Approaches And Challenges

IntroductionIn light of government and healthcare system commitments to reducing the carbon footprint of healthcare, health technology assessment (HTA) agencies are increasingly motivated to investigate how to consider environmental sustainability in their assessments and guidance. This constitutes a major departure from the existing remits and objectives of most agencies, which typically focus on improving population health outcomes. This presentation seeks to identify options for incorporating environmental impact data into HTA and to examine the main challenges, focusing on the National Institute for Health and Care Excellence (NICE) as a case study.MethodsWe present four broad approaches that could be pursued, informed by policy analysis undertaken by NICE. The strengths, weaknesses and implications of each approach are assessed.ResultsThe first option is to act as an ‘information conduit’, aggregating and distributing in a standardized format environmental impact information that is provided voluntarily by health technology manufacturers. The second is to present complementary analyses of environmental impact data, separately but alongside results from established health economic analyses (‘parallel evaluation’ model). The third is to incorporate environmental impact data into health economic analyses, for example by monetizing environmental outcomes, so that quantitative estimates of treatment value are directly affected by environmental benefits and costs (‘integrated evaluation’ model). The fourth is to create new decision-making frameworks for evaluating healthcare interventions that are not expected to improve health-related outcomes, but claim to have relative environmental benefits.ConclusionsWe conclude that these approaches are not mutually exclusive, and all involve some degree of benefit and risk. We explain why the parallel evaluation model may be the most appropriate approach for NICE as a first response to the increased demand for guidance on the environmental impact of health technologies. We also outline activities being undertaken by NICE and other agencies such as the Canadian Agency for Drugs and Technologies in Health to develop new methodologies for incorporating environmental impact data into their HTAs.

Development of the Orthodontic Treatment Impact Questionnaire: Cross-sectional validation

The need to involve patients in developing and evaluating health care interventions is now well-recognized. This study assesses and refines the Orthodontic Treatment Impact Questionnaire for use as a patient-reported outcome in an interventional clinical trial to evaluate and compare any orthodontic interventions. The face and content validity of a previously developed questionnaire were tested in 2 focus groups involving adolescents aged 11-17 years. They were wearing a range of orthodontic appliances and at different treatment stages. A similar cross-sectional convenience sample completed the questionnaire during routine appliance adjustment appointments. A Rasch model, using item response theory, was used for item reduction, assessment of the response format, and differential item functioning. Spearman's rank correlation was used to assess construct validity, Cronbach α for internal consistency and reliability, and intraclass correlation coefficient for test-retest reliability. Seven adolescents (4 females, 3 males) were involved in the initial testing; 181 (117 females, 64 males; mean age, 14.7 ± 1.5 years) completed the questionnaire once and 41 twice. The initial measure demonstrated a misfit to the Rasch model. Ten of the original 31 items had disordered thresholds and were removed. The 5-point scale was changed to a 3-point scale. None of the participants demonstrated a misfit to the model. Construct validity (P= 0.480), internal consistency (Cronbach α= 0.827) and test-retest reliability (intraclass correlation coefficient= 0.85; 95% confidence interval, 0.73-0.92) were good. The initial Orthodontic Treatment Impact Questionnaire was tested and modified using item response theory. The modified questionnaire demonstrated good construct validity, reliability, and internal consistency. Further testing to assess generalizability and longitudinal responsiveness is required.

Awareness and opinion of health professionals about various aspects of the implementation of HDSS

Introduction: The lack of appropriate health information obstructs population health assessments, as well as the development and evaluation of healthcare interventions. Surveillance is sometimes used interchangeably with epidemiology in its broadest definition, which is understandable. Surveillance, on the other hand, maybe considered to have evolved into a separate discipline from epidemiology. Objective: To study the Awareness and opinion of health professionals about various aspects of the implementation of HDSS in the defined rural community of district Jammu. Result: The present study was carried out in the Miran Sahib Zone of RS Pura Block, out of which six villages were selected randomly. The study surveyed 20 health professionals' over 3.56 km2 area of rural field practice area out of which 12 HPs had experienced less than 10 years while others had more than 10 years’ experience. The majority of health professionals were aware of various population enumeration methods while a small proportion of health professionals' about 25% considers the data generated by such systems to be useful for policy planning and prioritizing health services in a particular area.

Economic evaluations of health care interventions in oropharyngeal dysphagia after stroke: protocol for a systematic review

Background and purposeOropharyngeal dysphagia (OD) affects 40–81% of patients after stroke. A recent systematic review on the costs of OD and its main complications showed higher acute and long-term costs for those patients who developed OD, malnutrition and pneumonia after stroke. These results suggest that appropriate management of post-stroke OD could reduce clinical complications and costs. The purpose of this systematic review is to assess the available literature for healthcare interventions that are efficient or cost-effective in the management of OD.MethodsA systematic review on economic evaluations of health care interventions will be performed on post-stroke patients with OD following PRISMA recommendations. Four bibliographic databases will be searched and a subsequent reference check will be done. English and Spanish literature will be included without date restrictions. Studies will be included if they refer to economic evaluations or in which cost savings were reported in post-stroke patients suffering OD. Studies will be excluded if they are partial economic evaluation studies, if they refer to esophageal dysphagia, or if OD is caused by causes different from stroke. Evidence will be presented and synthetised with a narrative method and using tables. Quality evaluation will be done using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.DiscussionThe protocol for this systematic review is the first step to assess the cost-effectiveness of the healthcare interventions that have been described as potential treatments for post-stroke OD. This systematic review will summarise the current evidence on the relation between cost and benefits associated with the appropriate management of OD in post-stroke patients.Trial registrationPROSPERO CRD42020136245

Power analysis for cluster randomized trials with continuous coprimary endpoints.

Pragmatic trials evaluating health care interventions often adopt cluster randomization due to scientific or logistical considerations. Systematic reviews have shown that coprimary endpoints are not uncommon in pragmatic trials but are seldom recognized in sample size or power calculations. While methods for power analysis based on K ( ) binary coprimary endpoints are available for cluster randomized trials (CRTs), to our knowledge, methods for continuous coprimary endpoints are not yet available. Assuming a multivariate linear mixed model (MLMM) that accounts for multiple types of intraclass correlation coefficients among the observations in each cluster, we derive the closed-form joint distribution of K treatment effect estimators to facilitate sample size and power determination with different types of null hypotheses under equal cluster sizes. We characterize the relationship between the power of each test and different types of correlation parameters. We further relax the equal cluster size assumption and approximate the joint distribution of the K treatment effect estimators through the mean and coefficient of variation of cluster sizes. Our simulation studies with a finite number of clusters indicate that the predicted power by our method agrees well with the empirical power, when the parameters in the MLMM are estimated via the expectation-maximization algorithm. An application to a real CRT is presented to illustrate the proposedmethod.

Evidence-Based Medicine in Otolaryngology, Part XIII: Health Disparities Research and Advancing Health Equity.

To provide a contemporary resource for clinicians and researchers on health equity research and implementation strategies to mitigate or eliminate disparities in health care. Published studies and literature on health disparities, applicable research methodologies, and social determinants of health in otolaryngology. Literature through October 2021 was reviewed, including consensus statements, guidelines, and scientific publications related to health care equity research. This research focus provides insights into existing disparities, why they occur, and the outcomes of interventions designed to resolve them. Progress toward equity requires intentionality in implementing quality improvement initiatives, tracking data, and fostering culturally competent care. Priority areas include improving access, removing barriers to care, and ensuring appropriate and effective treatment. Although research into health care disparities has advanced significantly in recent years, persistent knowledge gaps remain. Applying the lens of equity to data science can promote evidence-based practices and optimal strategies to reduce health inequities. Health disparities research has a critical role in advancing equity in otolaryngology-head and neck surgery. The phases of disparities research include detection, understanding, and reduction of disparities. A multilevel approach is necessary for understanding disparities, and health equity extensions can improve the rigor of evidence-based data synthesis. Finally, applying an equity lens is essential when designing and evaluating health care interventions, to minimize bias. Understanding the data and practices related to disparities research may help promote an evidence-based approach to care of individual patients and populations, with the potential to eventually surmount the negative effects of health care disparities.

Abstract P4-11-19: Utilization of the RE-AIM frameworkfor evaluating the implementation of group medical visit for low-income breast cancer survivors

Abstract Introduction: Providing cost effective comprehensive survivorship care (SC) remains a major challenge for which optimal delivery models are needed. Group medical visits (GMV) are commonly used in chronic diseases to deliver medical care, education, and empower patients. Pilot GMV studies for breast cancer survivors (BCS) have shown increases in peer support and patient education. This pilot study uses the RE-AIM framework for evaluation of the GMV intervention to support breast cancer survivors. RE-AIM is an efficient framework for systematic evaluation of health care interventions. RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) is the evaluation methodology based on the framework developed by a working team of scholars from health care, public health, and implementation science. Methods: The study was conducted at a public hospital in California. GMV consisted of 4, 2-hour, weekly sessions focused on therapy side effects and prevention, emotional health, sexual health, physical activity, and diet. Patient navigator (PN) recruited 3 consecutive GMV groups of 6 English-speaking BCS (n=18). Results: The Reach was determined by the number and proportion of participants in this study. Our participants were primarily English-speaking and were within 1-5 years of completing active breast cancer treatment. Participants of the GMV were from diverse backgrounds and low-income neighborhoods in San Francisco and were representative of breast cancer survivors in our population. Effectiveness of GMV were assessed through self-reported changes with increased knowledge of survivorship care plans, recognition, and management of long-term side effects of cancer treatments and knowledge of community-based resources. There was an increase from baseline in all these domains and in confidence communicating with their primary care provider. Adoption involved initial stakeholder engagement in the intervention and Implementation was assessed by the consistent content and delivery of the intervention. We did not evaluate Maintenance as it was out of the scope of this study. We found that ongoing need for services is extremely high in our BCS, suggesting that this intervention has the potential to be widely adopted by cancer survivors and survivorship programs. Overall, consistent attendance and active participation indicated that GMV are feasible in this setting. 94% of BCS reported GMV increased their awareness and confidence of SC. Participants reported high satisfaction, felt well-informed, and supported through the availability of GMV. BCS highlighted the benefits of integrating treatment, services, emotional support, and education. BCS suggested GMV should be implemented at time of cancer diagnosis and emphasized the key role of PN in GMV and supporting SC. Conclusions: GMVs were specifically designed to address unmet needs for services that are necessary for SC but not readily available. Our pilot data suggests PN facilitated GMV are a feasible and acceptable model to integrate SC in public hospitals. The evaluation of our intervention using the RE-AIM framework can aid potential adopters in developing and implementing GMV intervention to support BCS. Citation Format: Evelin Trejo, Ana I. Velazquez, Elizabeth Castillo, Barbara Cicerelli, Robin McBride, Nancy J. Burke, Niharika Dixit. Utilization of the RE-AIM frameworkfor evaluating the implementation of group medical visit for low-income breast cancer survivors [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-19.