Building Evidence for Cost-effectiveness of Self-management Interventions in Chronic Care - Acknowledging Context and Mechanisms

Iiris Riippa

Building Evidence for Cost-effectiveness of Self-management Interventions in Chronic Care - Acknowledging Context and Mechanisms

Julkaisun otsikon käännös: Näytön kerryttäminen omahoitointerventioiden kustannusvaikuttavuudesta: kontekstin ja mekanismien huomiointi

Iiris Riippa

Tuotantotalouden laitos

Tutkimustuotos: Doctoral Thesis › Collection of Articles

Abstrakti

Pitkäaikaissairaiden potilaiden aktiivisen omahoidon on ehdotettu parantavan potilaan terveyttä ja vähentävän terveydenhuollon ammattilaisten antaman hoidon tarvetta ja kysyntää. Suurista odotuksista huolimatta, empiirinen näyttö omahoidon kustannusvaikuttavuudesta on vähäistä. Tämä saattaa johtua tutkimusmenetelmällisistä haasteista, joita omahoitointerventioiden kompleksisuus ja tyypillisesti viiveellä havaittavat vaikutukset aiheuttavat. Tässä tutkimuksessa omahoitointerventioiden vaikuttavuutta ja taloudellisuutta arvioitiin kahdessa erilaisessa tutkimusasetelmassa. Kustannusvaikuttavuuden kannalta keskeisten mekanismien ja kontekstitekijöiden ymmärtämiseksi tutkimuksessa hyödynnettiin realistisen arvioinnin lähestymistapaa. Haastatteluilla täydennetty retrospektiivisen kohorttitutkimus suomalaisessa perusterveydenhuollossa osoitti, että nykyiset rutiininomaisesti kerättävät hoitotiedot eivät kuvasta omahoitointerventioiden toimintamekanismia, eli potilaan parantunutta kykyä hallita omaa sairauttaan. Tutkimuksen toisessa empiirisessä osassa omahoitointervention vaikuttavuutta arvioitiin potilaan aktiivisuus -mittarilla (Patient Activation Measure, PAM), joka mittaa potilaan tietoja, taitoja ja itsevarmuutta oman sairautensa hoidossa. Suomenkielinen käännös PAM-kyselyinstrumentista validoitiin tutkimuksessa. Näennäiskoe ajankohtaisen omahoitointervention, sähköisen potilasportaalin, vaikuttavuudesta ja taloudellisuudesta osoitti, että potilaan mahdollisuus tarkastella omia hoitotietojaan ja viestiä sähköisesti ammattilaisten kanssa voivat parantaa potilaan aktiivisuutta kohtuullisin kustannuksin. Pääsy verrattain yksinkertaiseen sähköiseen potilasportaaliin voi täten parantaa hoidon kustannusvaikuttavuutta. Jotta potilasta aktivoivien investointien hyväksyttävyyttä voidaan arvioida tarkasti, tarvitaan lisää tutkimusta potilaan aktiivisuuden pitkäaikaisista vaikutuksista ja aktiivisuuteen liittyvistä maksuhalukkuuden kynnysarvoista. Potilasportaalin hyödyt syntyvät vaikutusmekanismeista, joita portaalin toiminnallisuudet saavat aikaan yhdessä kontekstitekijöiden kanssa. Potilasportaalin kannalta keskeisiä kontekstitekijöitä ovat portaalin käyttäjien ominaisuudet, ympäröivän terveydenhuoltojärjestelmän rakenteet sekä portaalin jalkauttaminen organisaatiossa. Tämä tutkimus osoittaa, että realistinen arviointi voi täydentää perinteisiä koetutkimuksia kompleksisten terveydenhuollon interventioiden kustannusvaikuttavuuden arvioinnissa.

Julkaisun otsikon käännös	Näytön kerryttäminen omahoitointerventioiden kustannusvaikuttavuudesta: kontekstin ja mekanismien huomiointi
Alkuperäiskieli	Englanti
Pätevyys	Tohtorintutkinto
Myöntävä instituutio	Aalto-yliopisto
Valvoja/neuvonantaja	Lillrank, Paul, Vastuuprofessori Linna, Miika, Ohjaaja
Kustantaja	Aalto University
Painoksen ISBN	978-952-60-6395-9
Sähköinen ISBN	978-952-60-6396-6
Tila	Julkaistu - 2015
OKM-julkaisutyyppi	G5 Artikkeliväitöskirja

Tutkimusalat

omahoito
pitkäaikaissairaus
kustannusvaikuttavuus
potilaan aktiivisuus
sähköinen potilasportaali

Pääsy asiakirjaan

http://urn.fi/URN:ISBN:978-952-60-6396-6Lisenssi: Määrittelemätön

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title = "Building Evidence for Cost-effectiveness of Self-management Interventions in Chronic Care - Acknowledging Context and Mechanisms",

abstract = "Involving the chronically ill in the management of their own health is proposed to improve the cost-effectiveness of chronic care by improving health outcomes and diminishing the need and demand for care provided by professionals. Despite high expectations, empirical evidence of the cost-effectiveness of self-management remains scant. This may be due to the methodological challenges posed by the often complex nature of the self-management interventions and difficulty in operationalizing their outcomes. In this study, two empirical evaluations with distinct designs were applied to gain understanding of the methodological considerations related to the cost-effectiveness evaluation of chronic care self-management interventions. Realist evaluation approach was applied to acknowledge the contextual factors and the mechanisms that induce the economic and health outcomes of a self-management intervention. The findings of a retrospective cohort analysis with interviews showed that the present administrative and clinical data that is routinely collected in primary care does not reflect the mechanism of self-management interventions, that is, the improvement in patients' ability to manage their condition. A Finnish translation of Patient Activation Measure (PAM), a viable instrument for assessing the effectiveness of self-management interventions, was validated and used as a measure for effectiveness in the second part of this study. A quasi-experiment on the effectiveness and economic outcomes of a novel self-management intervention, an electronic patient portal, showed that providing chronically ill patients with access to their own health records and secured messaging with the care provider may increase patient activation at an acceptable cost to the health care provider, and therefore be cost-effective. More research is needed to validate the acceptable thresholds for investments in patient activation. The benefits of an electronic patient portal are dependent on the mechanisms that its functionalities generate, and on the contextual factors such as the characteristics of the patients and the health care professionals using it, the health care system that it is adopted in, and its implementation in the organization. The empirical evidence from the two studies showed that realist evaluation can complement the traditional outcome trials in the pursuit of accumulating knowledge on cost-effectiveness of complex health care interventions, such as self-management interventions.",

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author = "Iiris Riippa",

year = "2015",

language = "English",

isbn = "978-952-60-6395-9",

series = "Aalto University publication series DOCTORAL DISSERTATIONS",

publisher = "Aalto University",

number = "142",

address = "Finland",

school = "Aalto University",

}

TY - BOOK

T1 - Building Evidence for Cost-effectiveness of Self-management Interventions in Chronic Care - Acknowledging Context and Mechanisms

AU - Riippa, Iiris

PY - 2015

Y1 - 2015

N2 - Involving the chronically ill in the management of their own health is proposed to improve the cost-effectiveness of chronic care by improving health outcomes and diminishing the need and demand for care provided by professionals. Despite high expectations, empirical evidence of the cost-effectiveness of self-management remains scant. This may be due to the methodological challenges posed by the often complex nature of the self-management interventions and difficulty in operationalizing their outcomes. In this study, two empirical evaluations with distinct designs were applied to gain understanding of the methodological considerations related to the cost-effectiveness evaluation of chronic care self-management interventions. Realist evaluation approach was applied to acknowledge the contextual factors and the mechanisms that induce the economic and health outcomes of a self-management intervention. The findings of a retrospective cohort analysis with interviews showed that the present administrative and clinical data that is routinely collected in primary care does not reflect the mechanism of self-management interventions, that is, the improvement in patients' ability to manage their condition. A Finnish translation of Patient Activation Measure (PAM), a viable instrument for assessing the effectiveness of self-management interventions, was validated and used as a measure for effectiveness in the second part of this study. A quasi-experiment on the effectiveness and economic outcomes of a novel self-management intervention, an electronic patient portal, showed that providing chronically ill patients with access to their own health records and secured messaging with the care provider may increase patient activation at an acceptable cost to the health care provider, and therefore be cost-effective. More research is needed to validate the acceptable thresholds for investments in patient activation. The benefits of an electronic patient portal are dependent on the mechanisms that its functionalities generate, and on the contextual factors such as the characteristics of the patients and the health care professionals using it, the health care system that it is adopted in, and its implementation in the organization. The empirical evidence from the two studies showed that realist evaluation can complement the traditional outcome trials in the pursuit of accumulating knowledge on cost-effectiveness of complex health care interventions, such as self-management interventions.

AB - Involving the chronically ill in the management of their own health is proposed to improve the cost-effectiveness of chronic care by improving health outcomes and diminishing the need and demand for care provided by professionals. Despite high expectations, empirical evidence of the cost-effectiveness of self-management remains scant. This may be due to the methodological challenges posed by the often complex nature of the self-management interventions and difficulty in operationalizing their outcomes. In this study, two empirical evaluations with distinct designs were applied to gain understanding of the methodological considerations related to the cost-effectiveness evaluation of chronic care self-management interventions. Realist evaluation approach was applied to acknowledge the contextual factors and the mechanisms that induce the economic and health outcomes of a self-management intervention. The findings of a retrospective cohort analysis with interviews showed that the present administrative and clinical data that is routinely collected in primary care does not reflect the mechanism of self-management interventions, that is, the improvement in patients' ability to manage their condition. A Finnish translation of Patient Activation Measure (PAM), a viable instrument for assessing the effectiveness of self-management interventions, was validated and used as a measure for effectiveness in the second part of this study. A quasi-experiment on the effectiveness and economic outcomes of a novel self-management intervention, an electronic patient portal, showed that providing chronically ill patients with access to their own health records and secured messaging with the care provider may increase patient activation at an acceptable cost to the health care provider, and therefore be cost-effective. More research is needed to validate the acceptable thresholds for investments in patient activation. The benefits of an electronic patient portal are dependent on the mechanisms that its functionalities generate, and on the contextual factors such as the characteristics of the patients and the health care professionals using it, the health care system that it is adopted in, and its implementation in the organization. The empirical evidence from the two studies showed that realist evaluation can complement the traditional outcome trials in the pursuit of accumulating knowledge on cost-effectiveness of complex health care interventions, such as self-management interventions.

KW - self-management

KW - chronic illness

KW - cost-effectiveness

KW - patient activation

KW - electronic patient portal

KW - omahoito

KW - pitkäaikaissairaus

KW - kustannusvaikuttavuus

KW - potilaan aktiivisuus

KW - sähköinen potilasportaali

KW - self-management

KW - chronic illness

KW - cost-effectiveness

KW - patient activation

KW - electronic patient portal

M3 - Doctoral Thesis

SN - 978-952-60-6395-9

T3 - Aalto University publication series DOCTORAL DISSERTATIONS

PB - Aalto University

ER -

Building Evidence for Cost-effectiveness of Self-management Interventions in Chronic Care - Acknowledging Context and Mechanisms

Abstrakti

Tutkimusalat

Pääsy asiakirjaan

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