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DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 1
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
Dr Tienie Stander, CEO of TCD Outcomes Research December 2016
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 2
Question: Can you imagine a world without any scarcity?
“I often say that when you can
measure what you are speaking
about, and express it in numbers,
you know something about it; but
when you cannot measure it, when
you cannot express it in numbers,
your knowledge is of a meagre
and unsatisfactory kind; it may be
the beginning of knowledge, but
you have scarcely in your thoughts
advanced to the state of Science,
whatever the matter may be.”
- Lord Kelvin
http://www.who.int/sdg/en/
Managing Change
“What you can’t measure,
you cannot manage.
What you cannot manage,
you cannot change.”
- Peter Drucker
WISDOM FROM THE PAST…
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 3
DOES IT LEAD TO BETTER OUTCOMES?
https://www.mhtf.org/2016/09/27/one-year-anniversary-of-the-sustainable-devel-opment-goals-sdgs-where-are-we-now/
INTERVENTION:• Vaccination
MEASUREMENT• Meningococcal meningitis
incidence•Serious adverse events
OUTCOME• Impact on BOD
YES / NO
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 4
OUTCOME A = OUTCOME B
OR
OUTCOME A < OUTCOME B
image: https://www.mhtf.org/2016/09/27/one-year-anniversary-of-the-sustainable-development-goals-sdgs-where-are-we-now/
INTERVENTION:• Vaccination
INTERVENTION:• Vaccination
MEASUREMENT• Meningococcal meningitis
incidence•Serious adverse events
OUTCOME A• Impact on BOD
OUTCOME B• Impact on BOD
THEREFORE, THE RESEARCH QUESTION IS …
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 5
• Death: Mortality outcomes
• Disease: Understand prevalence and incidence,
disease severity, responsiveness to treatment
• Disability: Level of functioning/impairment
• Discomfort: Pain, nausea, dyspnea, emotional
responses (e.g., distress, anger, sadness)
• Dissatisfaction: Patient perceptions of the quality
and other aspects of care
MEASUREMENT TYPES IN OR (LOHR, 1988)
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 6
• Safety: Pharmacovigilance
• Effectiveness: Does it actually work?
• Patient reported outcomes: From the
patient point of view
• Comparative effectiveness research:
Comparing effectiveness in the real world
• Registries: Observational technique
• Real world data analysis: Data bases
MEASUREMENT TECHNIQUES IN OR
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 7
EMPIRICAL EVIDENCE?
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 8
All health outcomes seek improvement.
We can measure health outcomes.
Therefore, measuring health outcomes seek
to improve.
All men are mortal.Socrates is a man.
Therefore, Socrates is mortal.
SyllogismAristotle used every form of deductive
reasoning: Syllogism is a form of deductive reasoning; Therefore,
Aristotle used syllogism
UNCOMMON COMMONSENSE
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 9
EVOLUTION OF EVIDENCE
Source: http://www.quintiles.com/~/media/library/presentations/the-emerging-role-of-real-world-studies-and-registries.pdf
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 11
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4720200/pdf/sfv122.pdf
PUBLIC HEALTH ZAMBIA MALARIA
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 12
An organized system that uses observational study methods to
collect uniform data (clinical and other) to evaluate specified
outcomes for a population defined by a particular disease, condition,
or exposure, and that serves one or more predetermined scientific,
clinical, or policy purposes
• Purpose and scope
• Good documentation
• Data quality
• Dissemination of findings
• Ethics
TECHNIQUES: REGISTRIES
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 13
TECHNIQUES: EPIDEMIOLOGICAL STUDIES
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 14
“CER is defined as research comparing interventions in the real world settings”1
1. http://www.med.upenn.edu/sleepctr/documents/FederalCoordinatingCoucilforCER_2009.pdf
TECHNIQUES: COMPARATIVE EFFECTIVENESS TRIALS (CER)
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 15
“While the implementation of CER has
implications across global healthcare
systems, the US focus on CER points to the
growing influence of payers and their desire
to control spending.”1
1. Nellesen et al. Pharmacoeconomics 2010; 28 (10): 789-798, 1170-7690/10/0010-0789/$49.95/0
TECHNIQUES: COMPARATIVE EFFECTIVENESS TRIALS (CER)
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 16
“In an era marked by increasing prominence
of CER evidence, successful pharmaceutical,
biotechnology and medical device manufacturers
will need to develop products with unambiguous
evidence of economic as well as clinical value
relative to alternatives.”1
1. Nellesen et al. Pharmacoeconomics 2010; 28 (10): 789-798, 1170-7690/10/0010-0789/$49.95/0
TECHNIQUES: COMPARATIVE EFFECTIVENESS TRIALS (CER)
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 17
Laboratory-based overnight polysomnography (PSG) is the gold
standard in clinical practice to diagnose OSA but has availability,
cost, and resource limitations. In the last decade, an alternative
diagnostic strategy, Portable Monitoring (PM) has emerged
1. Nellesen et al. Pharmacoeconomics 2010; 28 (10): 789-798, 1170-7690/10/0010-0789/$49.95/0
TECHNIQUES: CER EXAMPLE
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 18
“PRO is a health outcome directly reported by the patient
who experienced it.”
TECHNIQUES: PATIENT REPORTED OUTCOME STUDIES (PRO)
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 19
Examples:
• Symptoms (impairment)
• Functioning (disability)
• General health perceptions
• Quality of life
• Rating health care
RA and IBD
TECHNIQUES: PATIENT REPORTED OUTCOME STUDIES (PRO)
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 20
SUMMARY
• Data is power
• Yet, data is scarce
• Therefore we need to “create” data
• And convert data into intelligence
• That will inform rational policy information
• And improve health outcomes!
DATA
DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?
TCD OUTCOMES RESEARCH © 2016 | 21
OUTCOME A = OUTCOME B
OR
OUTCOME A < OUTCOME B
image: https://www.mhtf.org/2016/09/27/one-year-anniversary-of-the-sustainable-development-goals-sdgs-where-are-we-now/
INTERVENTION:• Vaccination
INTERVENTION:• Vaccination
MEASUREMENT• Meningococcal meningitis
incidence•Serious adverse events
OUTCOME A• Impact on BOD
OUTCOME B• Impact on BOD
THE ANSWER IS ...
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