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 21 st 2018
Advisory board The team • The Danish Medical Association • Danish Patients • Danish Health Authorities • KiAP Crown Prince University of Frederik Center Arizona for Public Leadership Research Unit for University of Manchester Imperial College London General Practice 2
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 Societal impact Patients GPs RBK End-users Input barriers The PINCH project Output barriers and facilitators and facilitators 3
Methods • A broad theoretical perspective: Public administration Behavioural Economic theory Psychology science economics • Timely and innovative experiments (low- and high-powered): Natural experiments RCT • Multitude of data sources: Administrative Clinical databases Interviews Surveys registers 4
Our framework Contextual factors Interventions Implementation of Socio-economic Barriers (changes in research-based impact /facilitators context ) knowledge P ersonal O • • Discontinuation Hospital admissions characteristics CAPITATION (ambulatory care of medication U sensitive conditions) T • I ncentives Spirometry • Cost of medication (monetary) NETWORK C • Microalbuminuria • Job market O N orms • participation HbA1C (Peers & third-party M NUDGE payer) • • Prescriptions Equity in access to E C onstraints in state-of-the art care S H ealth care WORKLOAD • Mortality (time & resources) 5
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 User Extrinsic orientation motivation Societal impact Patients GPs RBK End-users Intrinsic Public service motivation motivation 6
Work package 2: Incentives • Aim: To investigate how monetary incentives influence the implementation of RBK and the associated socioeconomic impact Reform : COPD and diabetes FFS CAP User Extrinsic orientation motivation Societal impact Patients GPs RBK End-users Intrinsic Public service motivation motivation Reform: All patients Flat CAP diff CAP 7
Work package 3: Norms • Aim: To investigate the effect of norms on GPs’ implementation of RBK and the associated socioeconomic impact Reform : Networks User Extrinsic orientation motivation Societal impact Patients GPs RBK End-users Intrinsic Public service motivation motivation RCT: Nudge 8
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 Reform : Diabetes Ambulatories GPs User Extrinsic Workload orientation motivation UK and DK Societal impact Patients GPs RBK End-users Public service Intrinsic motivation motivation 9
How does PINCH’s research reach end-users? - A taste of our own medicine Third-party payer GPs Patients Other academics The Danish authorities Danish Medical Association Danish Patients Channels Channels • • Advisory Board Presentations at national and international • The People’s meeting (“ Folkemødet ”) on conferences Bornholm • Publications in top peer- • Training courses for physicians reviewed journals • Periodicals • Twitter (@DaCHE) • Twitter (@DaCHE) 10
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