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Using a Health Economic Framework to Prioritize Quality Indicators: An Example With Smoking Cessation in Chronic Obstructive Pulmonary Disease
Background. Health care performance monitoring is a major focus of the modern quality movement, resulting in widespread development of quality indicators and making prioritizations an increasing focus. Currently, few prioritization methods of performance measurements give serious consideration to th...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6540504/ https://www.ncbi.nlm.nih.gov/pubmed/31192311 http://dx.doi.org/10.1177/2381468319852358 |
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author | Nam, Austin Naimark, David M. J. Stanbrook, Matthew B. Krahn, Murray D. |
author_facet | Nam, Austin Naimark, David M. J. Stanbrook, Matthew B. Krahn, Murray D. |
author_sort | Nam, Austin |
collection | PubMed |
description | Background. Health care performance monitoring is a major focus of the modern quality movement, resulting in widespread development of quality indicators and making prioritizations an increasing focus. Currently, few prioritization methods of performance measurements give serious consideration to the association of performance with expected health benefits and costs. We demonstrate a proof-of-concept application of using a health economic framework to prioritize quality indicators by expected variations in population health and costs, using smoking cessation in chronic obstructive pulmonary disease (COPD) as an example. Methods. We developed a health state transition, microsimulation model to represent smoking cessation practices for adults with COPD from the health care payer perspective in Ontario, Canada. Variations in life years, quality-adjusted life years (QALYs), and lifetime costs were associated with changes in performance. Incremental net health benefit (INHB) was used to represent the joint variation in mortality, morbidity, and costs associated with the performance of each quality indicator. Results. Using a value threshold of $50,000/QALY, the indicators monitoring assessment of smoking status and smoking cessation interventions were associated with the largest INHBs. Combined performance variations among groups of indicators showed that 81% of the maximum potential INHB could be represented by three out of the six process indicators. Conclusions. A health economic framework can be used to bring dimensions of population health and costs into explicit consideration when prioritizing quality indicators. However, this should not preclude policymakers from considering other dimensions of quality that are not part of this framework. |
format | Online Article Text |
id | pubmed-6540504 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-65405042019-06-12 Using a Health Economic Framework to Prioritize Quality Indicators: An Example With Smoking Cessation in Chronic Obstructive Pulmonary Disease Nam, Austin Naimark, David M. J. Stanbrook, Matthew B. Krahn, Murray D. MDM Policy Pract Article Background. Health care performance monitoring is a major focus of the modern quality movement, resulting in widespread development of quality indicators and making prioritizations an increasing focus. Currently, few prioritization methods of performance measurements give serious consideration to the association of performance with expected health benefits and costs. We demonstrate a proof-of-concept application of using a health economic framework to prioritize quality indicators by expected variations in population health and costs, using smoking cessation in chronic obstructive pulmonary disease (COPD) as an example. Methods. We developed a health state transition, microsimulation model to represent smoking cessation practices for adults with COPD from the health care payer perspective in Ontario, Canada. Variations in life years, quality-adjusted life years (QALYs), and lifetime costs were associated with changes in performance. Incremental net health benefit (INHB) was used to represent the joint variation in mortality, morbidity, and costs associated with the performance of each quality indicator. Results. Using a value threshold of $50,000/QALY, the indicators monitoring assessment of smoking status and smoking cessation interventions were associated with the largest INHBs. Combined performance variations among groups of indicators showed that 81% of the maximum potential INHB could be represented by three out of the six process indicators. Conclusions. A health economic framework can be used to bring dimensions of population health and costs into explicit consideration when prioritizing quality indicators. However, this should not preclude policymakers from considering other dimensions of quality that are not part of this framework. SAGE Publications 2019-05-27 /pmc/articles/PMC6540504/ /pubmed/31192311 http://dx.doi.org/10.1177/2381468319852358 Text en © The Author(s) 2019 http://www.creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Article Nam, Austin Naimark, David M. J. Stanbrook, Matthew B. Krahn, Murray D. Using a Health Economic Framework to Prioritize Quality Indicators: An Example With Smoking Cessation in Chronic Obstructive Pulmonary Disease |
title | Using a Health Economic Framework to Prioritize Quality Indicators:
An Example With Smoking Cessation in Chronic Obstructive Pulmonary
Disease |
title_full | Using a Health Economic Framework to Prioritize Quality Indicators:
An Example With Smoking Cessation in Chronic Obstructive Pulmonary
Disease |
title_fullStr | Using a Health Economic Framework to Prioritize Quality Indicators:
An Example With Smoking Cessation in Chronic Obstructive Pulmonary
Disease |
title_full_unstemmed | Using a Health Economic Framework to Prioritize Quality Indicators:
An Example With Smoking Cessation in Chronic Obstructive Pulmonary
Disease |
title_short | Using a Health Economic Framework to Prioritize Quality Indicators:
An Example With Smoking Cessation in Chronic Obstructive Pulmonary
Disease |
title_sort | using a health economic framework to prioritize quality indicators:
an example with smoking cessation in chronic obstructive pulmonary
disease |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6540504/ https://www.ncbi.nlm.nih.gov/pubmed/31192311 http://dx.doi.org/10.1177/2381468319852358 |
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