Does measurement lead to better health outcomes 20161202

DOES MEASUREMENT LEAD TO BETTER HEALTH OUTCOMES?

TCD OUTCOMES RESEARCH © 2016 | 1


Dr Tienie Stander, CEO of TCD Outcomes Research December 2016



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 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




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/





OUTCOME A• Impact on BOD

OUTCOME B• Impact on BOD

THEREFORE, THE RESEARCH QUESTION IS …



• 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)



• 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



EMPIRICAL EVIDENCE?



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



EVOLUTION OF EVIDENCE

Source: http://www.quintiles.com/~/media/library/presentations/the-emerging-role-of-real-world-studies-and-registries.pdf



CASE STUDIES



https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4720200/pdf/sfv122.pdf

PUBLIC HEALTH ZAMBIA MALARIA



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



TECHNIQUES: EPIDEMIOLOGICAL STUDIES



“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)



“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




“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





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


TECHNIQUES: CER EXAMPLE



“PRO is a health outcome directly reported by the patient

who experienced it.”

TECHNIQUES: PATIENT REPORTED OUTCOME STUDIES (PRO)



Examples:

• Symptoms (impairment)

• Functioning (disability)

• General health perceptions

• Quality of life

• Rating health care

RA and IBD

TECHNIQUES: PATIENT REPORTED OUTCOME STUDIES (PRO)



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



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/





OUTCOME A• Impact on BOD

OUTCOME B• Impact on BOD

THE ANSWER IS ...



[email protected]

www.tcd-global.com

Dynamic Solutions to Dynamic QuestionsTM

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Does measurement lead to better health outcomes 20161202

Health & Medicine