Periodic Reporting for period 2 - IQCE (Improving Quality of Care in Europe)
Berichtszeitraum: 2019-01-01 bis 2020-12-31
1) Improving the quality of health care and, in doing so, the health and wellbeing of people and populations across Europe requires drawing upon and also generating high-quality evidence in medical treatment and health services delivery. Previous research has not focused enough on identifying areas in which the quality of care is lacking, nor has it sufficiently explored the causes of low quality or developed adequate instruments to address it. This is precisely the springboard that the European Training Network (ETN) intends to use as it focuses on “Improving the Quality of Care in Europe” (IQCE) in its research programme.
2) The health care sector in Europe is a complex, adaptive system facing many challenges due to ageing populations, increasing demand, and the development of new technologies. Measuring and improving the quality of health care are crucial if Europe is to maintain its competitiveness in the global market and remain a healthy, equitable and prosperous place to live. High-quality research in this field can help deliver the social and technological solutions necessary to achieve these goals.
3) Overall objectives of the project
• generate new evidence and improve existing health economic research on the quality of care
• address research gaps through empirical, theoretical and experimental approaches with a focus on innovative econometric methods using novel databases
• establish close links between the PhD projects undertaken as part of the programme and the most relevant elements of health policy and practice
• train fellows to be experts in quality-of-care research and support them as they embark on the many career paths available in health economic research or practice
• help address the fragmentation of health economic research in Europe through better coordination, thus improving the competitiveness of European researchers
• serve as a model for joint PhD programmes in health economics in Europe
2) The health care sector in Europe is a complex, adaptive system facing many challenges due to ageing populations, increasing demand, and the development of new technologies. Measuring and improving the quality of health care are crucial if Europe is to maintain its competitiveness in the global market and remain a healthy, equitable and prosperous place to live. High-quality research in this field can help deliver the social and technological solutions necessary to achieve these goals.
3) Overall objectives of the project
• generate new evidence and improve existing health economic research on the quality of care
• address research gaps through empirical, theoretical and experimental approaches with a focus on innovative econometric methods using novel databases
• establish close links between the PhD projects undertaken as part of the programme and the most relevant elements of health policy and practice
• train fellows to be experts in quality-of-care research and support them as they embark on the many career paths available in health economic research or practice
• help address the fragmentation of health economic research in Europe through better coordination, thus improving the competitiveness of European researchers
• serve as a model for joint PhD programmes in health economics in Europe
• Recruitment: We recruited 15 fellows from 11 countries. Of these 15, 55% were from the EU and 60% were women.
• Teaching: The ESRs were trained to critically reflect and discuss topics in a multidisciplinary context with professionals with backgrounds in medical science, health sciences, epidemiology, economics, and other relevant disciplines. In total, 24 courses, 4 core, 6 core electives, 6 specialization courses, and 8 soft skill courses took place.
• Research: The IQCE programme is structured in clusters based on the dimensions of health care quality set out by the World Health Organization (WHO): effectiveness and safety, efficiency, access and equitability and acceptability. The research findings from all clusters are available as scientific publications, draft manuscripts or working papers.NUMBERS
• Dissemination & Communication: The findings of work undertaken by the fellows have been presented at large, high-impact international conferences as well as at several national conferences and workshops.
• Communication: Information on IQCE was presented at several public events, has appeared in several newsletters, online and social media. We also have conducted 12 video interviews with the fellows and made these available on the programme website.
• Teaching: The ESRs were trained to critically reflect and discuss topics in a multidisciplinary context with professionals with backgrounds in medical science, health sciences, epidemiology, economics, and other relevant disciplines. In total, 24 courses, 4 core, 6 core electives, 6 specialization courses, and 8 soft skill courses took place.
• Research: The IQCE programme is structured in clusters based on the dimensions of health care quality set out by the World Health Organization (WHO): effectiveness and safety, efficiency, access and equitability and acceptability. The research findings from all clusters are available as scientific publications, draft manuscripts or working papers.NUMBERS
• Dissemination & Communication: The findings of work undertaken by the fellows have been presented at large, high-impact international conferences as well as at several national conferences and workshops.
• Communication: Information on IQCE was presented at several public events, has appeared in several newsletters, online and social media. We also have conducted 12 video interviews with the fellows and made these available on the programme website.
1) Progress beyond the state of the art
A distinctive methodological feature of our research programme is that PhD topics 1-5, 7-11 and 14 have an empirical focus, using large databases of patient records that provide the necessary power to generate evidence with novel econometric techniques. Most of the databases have been made available only recently or have been provided exclusively to ETN fellows. The remaining PhD topics focus on theoretical (fellows 6, 12 and 13) and experimental research (fellow 15) to generate evidence in areas where little to no research has been undertaken to date.
2) Results
The PhD projects added substantial value over existing research in each of the four clusters:
(a) Effectiveness and safety: Previous research in this field has modelled interactions between physicians/organisations and patients and the effects of these on outcomes identifying evidence-based guidelines for decision-making. Drawing inferences from these interactions, however, requires a combination of health economic approaches to model the behaviour of individuals and organisations that is often lacking. The PhD projects in this cluster addressed precisely these limitations of previous studies.
(b) Efficiency: There is a long tradition in health economics of theoretically or empirically modelling regulatory regimes in health care markets and investigating their effects on welfare, consumer behaviour, prices, and other variables. Studies on the impact of different regulatory regimes or interventions on health outcomes, however, remain scarce. The PhD topics in this cluster investigated the incentives created by regulation and their effects on health outcomes.
(c) Access and equitability: Despite empirical evidence that differences in access exist, the causes of inequities in access and the impact of inequities on outcomes remain largely unclear. Two of the PhD projects in this cluster addressed this research gap by investigating differences in access to hospital care and specialist care. A third PhD project in this cluster developed a quality index to improve transparency of access for patients
(d) Acceptability: Investigating individual and societal preferences in health care and health care delivery is a growing field in health economics. Two PhD projects in this cluster focused on developing methods to measure societal preferences for allocation decisions. Another two investigated the effects of allocation decisions during the financial crises in Portugal and Italy.
2) Impacts
1) Enhancing the career prospects and employability of researchers and contributing to their skills development
• The ETN provided the skills needed to analyse contexts and relationships with the appropriate depth in health economics and beyond
• It also ensured the employability of researchers by providing fellows with the means to translate their research findings into practice – for example, through the participation of industrial supervisors in the research-in-progress workshops or opportunities for fellows to be seconded to industry partners.
• Beyond the formal programme, the ETN provided a number of opportunities for fellows to expand their networks through informal meetings with other fellows
2) Contribution to structuring doctoral/early-stage research training at the European level and to strengthening European innovation capacity
• Health economic research across Europe is rather fragmented. Through the active cooperation and communication in the ETN, we have achieved the better European-wide co-ordination of health economic research demonstrated in various intersintitutional projects and joint research papers of the ESRs.
• The effective communication and dissemination of the ETN program contributed to health economics being perceived as an important scientific field.
• From a practical perspective, there is high demand for trained health economists across Europe. The availability of highly skilled fellows from the ETN has potential to enhance the capacity of European enterprises to innovate.
A distinctive methodological feature of our research programme is that PhD topics 1-5, 7-11 and 14 have an empirical focus, using large databases of patient records that provide the necessary power to generate evidence with novel econometric techniques. Most of the databases have been made available only recently or have been provided exclusively to ETN fellows. The remaining PhD topics focus on theoretical (fellows 6, 12 and 13) and experimental research (fellow 15) to generate evidence in areas where little to no research has been undertaken to date.
2) Results
The PhD projects added substantial value over existing research in each of the four clusters:
(a) Effectiveness and safety: Previous research in this field has modelled interactions between physicians/organisations and patients and the effects of these on outcomes identifying evidence-based guidelines for decision-making. Drawing inferences from these interactions, however, requires a combination of health economic approaches to model the behaviour of individuals and organisations that is often lacking. The PhD projects in this cluster addressed precisely these limitations of previous studies.
(b) Efficiency: There is a long tradition in health economics of theoretically or empirically modelling regulatory regimes in health care markets and investigating their effects on welfare, consumer behaviour, prices, and other variables. Studies on the impact of different regulatory regimes or interventions on health outcomes, however, remain scarce. The PhD topics in this cluster investigated the incentives created by regulation and their effects on health outcomes.
(c) Access and equitability: Despite empirical evidence that differences in access exist, the causes of inequities in access and the impact of inequities on outcomes remain largely unclear. Two of the PhD projects in this cluster addressed this research gap by investigating differences in access to hospital care and specialist care. A third PhD project in this cluster developed a quality index to improve transparency of access for patients
(d) Acceptability: Investigating individual and societal preferences in health care and health care delivery is a growing field in health economics. Two PhD projects in this cluster focused on developing methods to measure societal preferences for allocation decisions. Another two investigated the effects of allocation decisions during the financial crises in Portugal and Italy.
2) Impacts
1) Enhancing the career prospects and employability of researchers and contributing to their skills development
• The ETN provided the skills needed to analyse contexts and relationships with the appropriate depth in health economics and beyond
• It also ensured the employability of researchers by providing fellows with the means to translate their research findings into practice – for example, through the participation of industrial supervisors in the research-in-progress workshops or opportunities for fellows to be seconded to industry partners.
• Beyond the formal programme, the ETN provided a number of opportunities for fellows to expand their networks through informal meetings with other fellows
2) Contribution to structuring doctoral/early-stage research training at the European level and to strengthening European innovation capacity
• Health economic research across Europe is rather fragmented. Through the active cooperation and communication in the ETN, we have achieved the better European-wide co-ordination of health economic research demonstrated in various intersintitutional projects and joint research papers of the ESRs.
• The effective communication and dissemination of the ETN program contributed to health economics being perceived as an important scientific field.
• From a practical perspective, there is high demand for trained health economists across Europe. The availability of highly skilled fellows from the ETN has potential to enhance the capacity of European enterprises to innovate.