APPENDIX A
Workshop Agenda, Particpants, and Questions for the Working Groups
WORKSHOP ON SUMMARY MEASURES OF POPULATION HEALTH STATUS
AGENDA
Plenary Session
2101 Constitution Avenue, N.W., Washington, D.C
FRIDAY, DECEMBER 12 Lecture Room, National Academy of Sciences |
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7:30 a.m. |
Continental Breakfast and Workshop Registration |
8:30 |
SETTING THE STAGE |
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Welcome, Introductions, and Overview Kenneth Shine, M.D. President, Institute of Medicine |
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Harvey Fineberg, M.D., IOM Workshop Chair Provost, Harvard University |
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Workshop Overview Marilyn Field, Ph.D. Deputy Director, Health Care Services, IOM |
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Marthe Gold, M.D., M.P.H., Project Consultant City University of New York Medical School |
9:00 |
APPLICATIONS OF MEASURES Examples of efforts to apply measures to real populations: Objectives, problems encountered, lessons learned, future directions |
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Michael Wolfson, Ph.D. Director, General Institutions and Social Statistics Branch Statistics Canada |
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Edward Sondik, Ph.D. Director, U.S. National Center for Health Statistics |
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Paige Sipes-Metzler, D.P.A. Manager, Oregon Blue Cross and Blue Shield Former Executive Director, Oregon Health Commission |
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Louise Gunning-Schepers, Ph.D. Professor, Department of Social Medicine, Amsterdam, Netherlands |
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James Marks, M.D., M.P.H. Director, U.S. National Center for Chronic Disease Prevention and Health Promotion |
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Howard Seymour, M.D. Director, Health Care Development Unit, United Kingdom |
11:00 |
METHODOLOGICAL ISSUES QALYs, DALYs, and other measures: Purposes, concepts, assumptions, data requirements, issues, problems and possible solutions |
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Dennis Fryback, Ph.D. Professor of Preventive Medicine, University of Wisconsin |
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Christopher Murray, Ph.D. Harvard School of Public Health |
1:15 |
METHODOLOGICAL QUESTIONS (continued) |
2:00 |
ETHICAL ISSUES Principles for evaluating measures, preferences and perspectives, role of ethics |
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Norman Daniels, Ph.D. Professor of Philosophy, Tufts University |
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Daniel Brock, Ph.D. Professor of Philosophy, Brown University |
3:50 |
PERSPECTIVES OF DECISIONMAKERS AND POTENTIAL USERS |
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Bruce Fried, Ph.D., and Jeffrey Kang, Ph.D. U.S. Health Care Financing Agency |
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Barbara DeBuono, M.D. Commissioner of Health, State of New York |
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Steven Safyer, M.D. Vice President, Medical Affairs, Montefiore Medical Center |
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Jean-Pierre Poullier, Ph.D. Organization for Economic Cooperation and Development |
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John Eisenberg, M.D. Administrator, U.S. Agency for Health Care Policy and Research |
5:30 |
CONCLUDING REMARKS |
Working Groups
2001 Wisconsin Avenue, N.W., Washington, D.C.
SATURDAY, DECEMBER 13 |
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8:00 a.m. |
Continental Breakfast |
8:30 |
GENERAL SESSION—CHARGE TO WORKING GROUPS |
9:00 |
WORKING GROUPS |
12:00 noon |
Lunch in Working Groups |
1:00 p.m. |
REPORTS FROM WORKING GROUPS |
4:00 p.m. |
Adjourn |
PARTICIPANTS
Sudhir Anand, M.D.
Acting Director, Harvard School of Public Health
Harvard Center for Population and Development Studies
Linda A. Bailey, J.D., M.H.S.
Senior Advisor for Health Policy
U.S. Department of Health and Human Services
Judith Bale, Ph.D.
Director, Board on International Health
Institute of Medicine
John Bartlett, M.D., M.P.H.
Atlanta, GA
Bobbie Berkowitz, Ph.D., R.N.
Deputy Director, Turning Point Program, School of Public Health and Community Medicine
University of Washington
Stanley Berman, Ph.D.
Economist, National Institutes of Health
Jo Ivey Boufford, M.D.
Dean, Robert F. Wagner Graduate School of Public Services
New York University
Peter Bouxsein, J.D.
Acting Director, Office of Clinical Standards and Quality
Health Care Financing Administration
A. David Brandling-Bennett, MD
Deputy Director, Pan American Health Organization
Dan W. Brock, Ph.D.
University Professor and Director, Center for Biomedical Ethics, Brown University
Claire V. Broome, MD
Deputy Director, Centers for Disease Control and Prevention
Ronald H. Carlson
Director, Office of Planning, Evaluation, and Legislation
Health Resources and Services Administration
Cheryl Austein Casnoff, M.P.H.
Director, Public Health Policy, Office of the Assistant Secretary for Planning and Evaluation
Nelba Chavez, M.D.
Administrator, Substance Abuse and Mental Health Services Administration
Carolyn Clancy, M.D.
Director, Center for Outcomes and Effectiveness Research
Agency for Health Care Policy and Research
Barbara A. DeBuono, M.D., M.P.H.
Commissioner of Health, State of New York
John Eisenberg, M.D.
Administrator, Agency for Health Care Policy and Research
U.S. Department of Health and Human Services
Pennifer Erickson, Ph.D.
Departments of Health and Human Development and Health Evaluation Sciences
Pennsylvania State University
Claude Earl Fox, M.D., M.P.H.
Acting Administrator, Health Resources and Services Administration
Spencer Foreman, M.D.
President, Motefiore Medical Center
New York City
Julio Frenk, M.D., M.P.H., Ph.D.
Executive Vice President, Mexican Health Foundation, MEXICO
Bruce M. Fried, Ph.D.
Director, Center for Health Plans and Providers
Health Care Financing Administration
Kristine Gebbie, R.N., Dr.P.H., F.A.A.N.
Associate Professor, Columbia University School of Nursing
Louise J. Gunning-Schepers, Ph.D.
Department of Social Medicine
Amsterdam Medical Center, THE NETHERLANDS
Jeffrey R. Harris, M.D., M.P.H.
Director, Division of Prevention Research and Analytic Methods
Centers for Disease Control and Prevention
Frances Kamm, Ph.D.
Department of Philosophy
New York University
Jeffrey Kang, M.D.
Chief Medical Officer, Center for Health Plans and Providers
Health Care Financing Administration
Robert Kaplan, Ph.D.
Department of Family and Preventive Medicine
University of California San Diego
Paul Kind
Senior Researcher, University of York
UNITED KINGDOM
David Kindig, M.D. Ph.D.
Professor of Preventive Medicine
Director, WI Network for Health Policy Research
University of Wisconsin-Madison
Richard J. Klein
Chief, Data Monitoring and Analysis Branch
Division of Health Promotion Statistics
National Center for Health Statistics
Jeffrey P. Koplan, M.D.
President, The Prudential Center for Healthcare Research
Samuel P. Korper, Ph.D., M.P.H.
Associate Director of National Intstitute on Aging/NIH
Sr. Advisor, Substance Abuse and Mental Health Services Administration
Donald P. Marazzo, M.D.
Pittsburgh, PA
James S. Marks, M.D., M.P.H.
Director, National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Kristine McCoy
Alexandria, VA
Michael McGinnis, M.D.
Scholar-in-Residence, Commission on Behavioral and Social Sciences and Education
National Research Council
Matthew McKenna, M.D., M.P.H.
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Paul Menzel, Ph.D.
Provost, Pacific Lutheran University
David Moriarty
Centers for Disease Control and Prevention
Richard H. Morrow, M.D.
Director of Health Systems
Johns Hopkins University
Gregory Pappas, M.D., Ph.D.
Senior Public Health and Population Adviser
Office of International and Refugee Health
Jean-Pierre Poullier, Ph.D.
Office for Economic Co-operation and Development
Office of the Secretariat
FRANCE
Steven M. Safyer, M.D.
Vice President, Medical Affairs and Chief Medical Officer
Montefiore Medical Center
Howard Seymour, M.D.
Director, Health Care Development Unit
UNITED KINGDOM
Joanna Siegel, Sc.D.
Arlington Health Foundation
Clay Simpson, Ph.D.
Deputy Assistant Secretary for Minority Health
Office of Minority Health
Edward J. Sondik, Ph.D.
Director, National Center for Health Statistics
Dixie Snider, M.D., M.P.H.
Associate Director for Science
Centers for Disease Control and Prevention
Susanne A. Stoiber
Deputy Assistant Secretary for Program Systems
U.S. Department of Health and Human Services
Richard Surles, Ph.D.
President, Advanced Clinical Delivery
Merit Behavioral Care
Steven Teutsch, M.D.
Senior Research Scientist, Outcomes Research and Management
Merck and Co., Inc.
Joseph Thompson
National Committee for Quality Assurance
Martin Tobias, M.D.
Ministry of Health
NEW ZEALAND
Reed Tuckson, M.D.
Group Vice President for Professional Standards
American Medical Association
Peter Ubel, MD
Center for Bioethics
University of Pennsylvania
Diane K. Wagener, Ph.D.
Acting Director, Division of Health Promotion Statistics, Office of Analysis, Epidemiology and Health Promotion
National Center for Health Statistics
Daniel Wikler, Ph.D.
Professor, Medical School
University of Wisconsin
Alan Williams, Ph.D.
Professor of Economics
University of York, UNITED KINGDOM
Michael Wolfson, Ph.D.
Director, General Institutions and Social Statistics Branch
Statistics Canada, CANADA
QUESTIONS FOR THE WORKING GROUPS
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Summary measures of population health status have been devised for various purposes. For the settings listed below, how useful would a summary measure be in providing information or insights not provided by other measures of health? What uses should have the highest priority in future efforts to develop and apply summary measures?
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For public health surveillance/burden-of-disease monitoring at national/regional levels.
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For comparing population health between/among countries/states/regions.
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For resource allocation at national/regional levels.
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For monitoring and comparing performance in managed care or similar settings.
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For devising risk-adjusted capitation payments for use with managed care plans or other health care providers paid in whole or in part on a per-person basis.
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For measuring health-related quality of life in clinical trials and contributing to cost-effectiveness analyses of alternative clinical interventions.
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Other (discuss).
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The practicality, credibility, and understandability of summary measures in different settings or for different constituencies is an important issue.
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What problems of understanding or credibility do you see as deterrents to the use of summary measures in the settings of most concern to you?
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Would these measures be comprehensible and credible to the constituencies that you serve or for whom you make decisions?
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What efforts (e.g., education, survey of value systems, media coverage) would contribute to their comprehensibility or credibility?
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Societal values (e.g., equity) may figure in decision making in different ways. For example, they may be among specific criteria used to evaluate measurement data and assess different options. Alternatively, value judgments can be incorporated in the construction of measures themselves (e.g., by assigning elements of a measure different weights).
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To what extent would measures be more useful if they took explicit account of distributive/equity issues (e.g., related to disability or chronic disease burdens across different sociodemographic groups based on such variables as age, race, gender, or income)?
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What social value or ethical issues should be emphasized in future efforts to develop and apply summary measures?
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Certain summary measures incorporate information about preferences for living with different kinds of disabilities or illnesses.
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For the uses listed in question 1, how relevant or central to credibility is the inclusion of such preferences into the measures themselves? Are there decision-making contexts where preferences are not necessary?
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Where preferences are important to incorporate, whose preferences (e.g., patient, community) are most relevant in the different decision-making contexts?
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What issues related to preferences should be priorities for attention in future work to develop and apply summary measures?
How important is it that a single summary measure be suited to a range of different uses?
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What different goals or aspects of health might warrant different measures?
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What are the trade-offs to consider in using single versus multiple measures?