To deliver evidence of value improvement in health care delivery (VALUE), draw out its implications for health care budgets (AFFORDABILITY), and sketch its consequences for the sustainable organization of care (SUSTAINABILITY).
Value, affordability & sustainability
Increasing pressure on public health spending, growing demand for health care, the rapid pace of introducing new and expensive health interventions (treatments, diagnosis, prevention), and an ageing population together call for innovative ways to organize care and other means to evaluate and fund these interventions. The current health care system is also struggling with overtreatment, undertreatment, overdiagnosis, underdiagnosis, and other factors that lower the impact of health care. As a consequence, providers have to cope with rising costs. One possible way to arrive at a more sustainable health care system might be to focus on the measurement of value in terms of how well the delivered care meets individual patients’ needs. These needs may be different for each person, and what constitutes the best intervention may be different for each patient. To deal with these issues at a societal level, we intend to carry out investigations that take a multidisciplinary approach in which the clinical, economic, business, decision science, and public health perspectives come together.
The ultimate goal of the new research program VALUE is to increase the benefits for patients by identifying and generating supporting evidence for the best health interventions that an optimally organized health care system could provide. An interim goal is to assemble the evidence that certain strategies can prevent the onset of disease in people or a decline in their health condition. In particular, our research will take into account the perspectives of both patients and policy makers. It will incorporate end-outcomes such as perceived health status, well-being, and health-related quality of life in the evaluation of the overall effect of interventions. The program will focus on efficacy, cost-effectiveness, well-being measurement, burden of disease, perceived health-status monitoring, and cost-of-illness studies. Its scope will be broad: cost-effectiveness analysis, simulation modeling, patient-reported health outcomes studies, scenario analyses, preference studies, policy research, and qualitative research. Its output will range from fundamental methodological analyses, for example developing new modeling techniques for infectious and chronic diseases, to state-of-the-art studies that are policy-oriented and timely. The program strives to make a strong societal impact with its high-quality research. Intensive use will be made of distinct observational datasets and combinations of large databases (Big Data).
This theme is method-driven and covers one of the most important toolsets available to health economists. With competence in a wealth of modeling methods, the level of multidisciplinary expertise in Groningen is unique. Irrespective of the discipline, models serve to combine all available clinical and economic evidence in a consistent way so they can support extrapolation over time and/or settings. Depending on the research question at hand, VALUE researchers select the most appropriate modeling method. Many ongoing projects make extensive use of real world data. Stratified treatment strategies and the smart organization of care provide clear links to the other two VALUE themes (i.e., measurement and organization). Our applications support all levels of health care policy making, from projects commissioned by EU agencies to analyses aimed at new prediction models for supporting decisions at the individual patient level. Besides developing a broad range of state-of-the-art applications, we actively contribute to the improvement and extension of the toolbox by conducting methodological research into better modeling methods.
For many modeling and simulation studies, it is crucial to have accurate measures of specific health states. Therefore, considerable effort goes into developing and using advanced and robust methodologies to measure health outcomes, both over the life cycle and in specific domains such as the elderly, patients with multi-morbidity, children and newborns, and transplant patients. Health outcomes can be specific or broad, ranging from functional health status and perceived health status to health-related quality of life and well-being. Health outcome measures are used to signal change over time in the health of a population or individuals, to evaluate the effects of personalized prevention strategies, to evaluate health intervention programs, and to determine the cost-effectiveness of health interventions. Standardized health outcome measures are needed to inform clinical or policy decisions. Such measures are also needed to signal health differences (including inequalities) across populations and can be used alongside the patient-specific information collected by care providers to better understand both the causes and consequences of differences in health.
Health organization & policy
The way health care is organized can have a considerable impact on its service outcomes and sustainability. For example, the number of surgical procedures performed per surgeon or center may have a substantial impact on patient outcomes. Centralization of highly specialized health services (e.g., emergency care, childhood oncology) may create facilities that operate better with less variation in performance. Collaboration with other health care partners enables the design of optimal acute care pathways, taking into account aspects such as health outcomes, travel time, care capacity, and costs. These redesigned pathways call for effective implementation strategies. Value in the health care sector comprises multiple attributes, which are determined by the patient. Value-based health care, for example, requires the redesign of the delivery along optimized pathways by multidisciplinary teams.
VALUE is an interdisciplinary group. Its participants have backgrounds in the medical sciences, pharmacy, psychology, economics, business studies, econometrics, and statistics.
PIs and postdocs participating in VALUE are members of national and international committees: ZonMW, Health Council, Joint Committee of Vaccination & Immunization, All Wales Medicines Strategy Group, EuroQol Research Foundation, ZINL/WAR.