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Health metrics and evaluation is an emerging field used to evaluate overall health and treat quality effectiveness as well as determine resource allocation, program and system selection, and policy choices. Collecting and measuring health data provides a solid scientific foundation for decision makers to make educated, cost-effective choices regarding program quality and improvement.
In the past, the costliness of developing measurement tools and the inability to compare unique tools across projects limited much needed progress in this field. However, there is a real need to establish uniform health metrics, and doing so would serve a number purposes. Standardizing health metrics would:
Note: The case studies put forth here will primarily be limited to the challenges of and solutions to measuring disease outcomes and management rather than global health policy choices and program implementation.Relevance
Establishing common metrics will allow us to measure health outcomes of specific projects and to compare results across similar health improvement initiatives. However, institutional and cultural challenges have hindered the use of evidence-based metrics. This section outlines a number of relevant barriers:
Expanding and standardizing the use of health metrics will require policies and practices to address the barriers mentioned above.
In recent years, both emerging and developed countries have been under enormous pressure to improve healthcare performance and allocate resources as efficiently as possible. To facilitate this process a number of independent organizations have initiated their own outcome measurement projects as well as establishing organizations to support other countries’ efforts. Examples include:Healthcare Productivity Study (October 1996)
McKinsey Global Institute
This extensive study assessed the United Kingdom, United States and Germany’s health care systems to assess productivity levels at the disease level, the major source of these differences, and implications. The study identified common inputs for four common diseases (diabetes, gall stones, breast cancer, and lung cancer) and compared these metrics across countries. For example,
the diabetes epidemic
Henrik Støvring, et al. (Denmark)
This project used pharmacoepidemiological databases –readily available in the Nordic countries – as a proxy for incidence rates. The researchers sought to determine if such databases could be used instead of costly population studies on the incidence rate and mortality of diabetes.
The researchers obtained data on all 470,000 inhabitants in Funen County, Denmark, in the period 1992–2003, including gender, date of birth, death and migration to and from the county, and any filled prescriptions of an anti-diabetic medication from the Odense Pharmaco-Epidemiological Database.
Researchers concluded that the pharmacoepidemiological databases provide a useful tool for monitoring pharmacologically treated diabetes (e.g. to obtain incident rates and severity measures); however, a dedicated diabetes database covering all prevalents and incidents is needed for a more detailed analysis of underlying causes and trends.Institute for Health and Productivity Management (USA)
The Institute for Health and Productivity Management was created in 1997 to make employee health an investment in corporate success through enhanced workplace performance. The effort is based on a joint effort by the National Business Coalition on Health and the National Association of Managed Care Physicians.
Employers' desire for value has led them to insist that costs be controlled while quality is measured and improved. But their concept of value has been limited mostly to the results of care being delivered to "patients" who happen to be their employees. A larger concept of value looks beyond just getting sick people well or even back to work. It expands the definition of value to include employee performance on the job, i.e. productivity. Health promotion and care delivery models organized to produce outcomes that have a positive impact on the bottom line of total labor costs--rather than just health care costs--get us on to the next higher level of value for the health benefit dollar.
Institute for Health Metrics and Evaluation
University of Washington
The Institute for Health Metrics and Evaluation (IHME) is funded in part by a grant from the Bill and Melinda Gates Foundation and the State of Washington. IHME monitors global health conditions and health systems, as well as evaluates interventions, initiatives, and reforms. IHME provides high quality and timely information on health so that policymakers, researchers, donors, practitioners, local decision-makers, and others can better allocate limited resources to achieve optimal results. The Institute uses quantitative analysis and other analysis techniques to investigate: Health Outcomes; Health Services; Resource Inputs; Decision Analytics; and Evaluations.Pacific Business Group on Health
The Pacific Business Group on Health (PBGH), a business coalition of 50 purchasers, seeks to improve the quality and availability of health care while moderating cost. Since 1989, PBGH has worked with state and national organizations to promote health care measurement, trend moderation, and system accountability through public reporting of data. PBGH seeks to 1) increase the availability and usability of quality and economic efficiency performance information for all levels of care: health plans, hospitals, medical groups and individual physicians and 2) identify high impact methods to improve performance and create market demand for adoption by plans and providers through effective value purchasing and consumer engagement efforts.The Health Metrics Network (HMN)
World Health Organization
The Health Metrics Network (HMN) is a global partnership that facilitates better health information at country, regional and global levels. Partners include developing countries, multilateral and bilateral agencies, foundations, other global health partnerships and technical experts. HMN seeks to bring together health and statistical constituencies to build capacity and expertise and enhance the availability, quality, dissemination and use of data for decision-making.Institute for Health Metrics (US)
The Institute for Health Metrics is a privately funded not-for-profit organization focused on developing an electronic data analytics system to support quality and operational improvement in hospitals and research in public health and health care services.
IHM's goal is to become a national, collaborative organization working with and on behalf of community hospitals to improve the quality, safety and efficiency of health care. Using its unique ability to organize and analyze data from disparate hospital clinical information systems, IHM hopes to transform data into actionable insight that enables hospitals to understand and improve all aspects of their care processes.