The PIN INCH proje ject Professor Dorte Gyrd-Hansen Danish Centre - - PowerPoint PPT Presentation

Regulating and nudgin ing for im improved societal l im impact of research based kn knowledge in in healt lth care

The PIN INCH proje ject

Professor Dorte Gyrd-Hansen Danish Centre for Health Economics, DaCHE

September 21st 2018

The team

2

Research Unit for General Practice University of Manchester Crown Prince Frederik Center for Public Leadership University of Arizona Imperial College London Advisory board

• The Danish Medical Association
• Danish Patients
• Danish Health Authorities
• KiAP

Motivation

• Key question: How do we ensure that the knowledge generated by large investments in

research reaches our end-users and generates societal impact in terms of improved health and increased productivity?

• The general practitioners (GPs) - who are visited by 85% of citizens annually - are key to

ensuring that research based knowledge (RBK) reaches the end-users

3

GPs Patients

End-users

RBK Societal impact

Input barriers and facilitators

 The PINCH project 

Output barriers and facilitators

Methods

• A broad theoretical perspective:
• Timely and innovative experiments (low- and high-powered):
• Multitude of data sources:

4

Interviews Surveys Administrative registers Clinical databases Natural experiments RCT Economic theory Behavioural economics Psychology Public administration science

Our framework

5

Contextual factors Barriers /facilitators Interventions (changes in context ) Implementation of research-based knowledge Socio-economic impact

Norms

(Peers & third-party payer)

Incentives

(monetary)

Constraints in Health care

(time & resources)

Personal

characteristics

NETWORK CAPITATION NUDGE

O U T C O M E S

• Discontinuation
• f medication
• Spirometry
• Microalbuminuria
• HbA1C
• Prescriptions
• Hospital admissions

(ambulatory care sensitive conditions)

• Cost of medication
• Job market

participation

• Equity in access to

state-of-the art care

• Mortality

WORKLOAD

Work package 1: Personal characteristics

• Aim: To investigate whether GPs’ personal characteristics and motivation profiles are

important explanatory factors for understanding variation in GPs' implementation of RBK and the associated socioeconomic impact

6

GPs Patients

End-users

RBK Societal impact

Public service motivation User

• rientation

Intrinsic motivation Extrinsic motivation

GPs Patients

End-users

RBK Societal impact

Public service motivation User

• rientation

Intrinsic motivation Extrinsic motivation

Work package 2: Incentives

• Aim: To investigate how monetary incentives influence the implementation of RBK and

the associated socioeconomic impact

7

Reform: COPD and diabetes FFS  CAP Reform: All patients Flat CAP  diff CAP

Work package 3: Norms

• Aim: To investigate the effect of norms on GPs’ implementation of RBK and the

associated socioeconomic impact

8

Reform: Networks RCT: Nudge

GPs Patients

End-users

RBK Societal impact

Public service motivation User

• rientation

Intrinsic motivation Extrinsic motivation

Workload UK and DK

Work package 4: Resource Constraints in Health care

• Aim: To investigate the effect of resource constraints on the implementation of RBK and

the associated socioeconomic impact

9

GPs Patients

End-users

RBK Societal impact

Reform: Diabetes Ambulatories  GPs Public service motivation User

• rientation

Intrinsic motivation Extrinsic motivation

How does PINCH’s research reach end-users?

• A taste of our own medicine

10

Other academics GPs

Danish Medical Association

Patients

Danish Patients

Third-party payer

The Danish authorities

Channels

• Advisory Board
• The People’s meeting (“Folkemødet”) on

Bornholm

• Training courses for physicians
• Periodicals
• Twitter (@DaCHE)

Channels

• Presentations at national

and international conferences

• Publications in top peer-

reviewed journals

• Twitter (@DaCHE)