Micro level: submission of vignettes and collection of data WP3 Micro level: submission of vignettes and collection of data 3rd November 2011, Milan Italian team

WP3: Overall task To identify a methodology for cost measurement in primary care both at Macro and at Micro level

Micro level The main goal of the consortium at the Micro level is to cost specific and relevant clinical cases for which care is provided in the primary care system context, in each partner country

Micro level - Methodology STEPS To choose the vignettes V To translate the vignettes V To validate the vignettes V To submit the vignettes to primary care professionals To collect data To measure resources consumption in the delivery of services involved in the clinical vignettes To describe how certain primary care cases are managed in different systems

Translation of vignettes To translate the vignettes The translation procedure consisted of three steps: Translation of the vignettes and questionnaires from English to Local language, involving a language expert Translation of the vignettes and questionnaires from Local language to English, involving a different language expert Comparison between the original English version of the vignettes and the one resulting from the double translation

Translation of vignettes To translate the vignettes: results from back translations Vignette 1 Vignette 2 Vignette 3 Vignette 4 Spain ok minor differences Germany minor differences + additional questions Finland Hungary Lithuania Estonia  

Validation of vignettes To validate the vignettes After having properly translated the vignettes and the questionnaires, the four scenarios have to be validated by professionals. The validation requires the involvement of 3 to 5 professionals, to be chosen among those who mainly follows the patient in the specific scenarios described. Obviously, the same professional will validate more than one vignettes. Italy did the validation by interviewing 2 general practitioners and 1 paediatrician: the GPs answered on vignettes 1, 3 and 4, while the paediatrician answered on vignette 2. Partners were supposed to validated vignettes by 17th October  NO PROBLEMS HAVE OCCURED

Submission of vignettes To submit the vignettes to primary care professionals Once validated and translated, vignettes are to be submitted to primary care professionals in each country. The choice of respondents for each vignette is based on types of professionals mainly involved. Which Professionals? GP Paediatrician PC nurse Specialist Other V.1 - Vaccination 6   5 1 V.2 - Child bronchitis 4 V.3 - Diabetic patient 7 3 V.4 - Health promotion -Smoking cessation

Submission of vignettes To submit the vignettes to primary care professionals Vignettes have to be submitted: personally, by interviewers from each country to a group of professionals of the same kind (e.g., a group of GPs, a group of paediatricians, a group of nurses): the number of the members for each group will be 25 to 30 and different vignettes could be submitted to the same group through a written questionnaire: professionals of each group will be requested to answer to the questions related to each vignette in writing

Submission of vignettes To submit the vignettes to primary care professionals Recommendations each country has to abide to the minimum number of professionals to be interviewed for each professional figure involved (= 25). However, professionals can be cluster in smaller groups that interviewers meet at different time (for instance, you can interview 2 groups of 15 general practitioners each)  Italy: we have already submitted vignettes to 24 GPs of the Emilia-Romagna region, clustered in groups of 4 in the same day. Our goal is to interview 30 GPs it is extremely important that each vignette is submitted only to a group of professionals; on the contrary, more than one vignette could be submitted to the same group  Italy: we have submitted vignette 1, 3 and 4 to the 24 GPs

Submission of vignettes To submit the vignettes to primary care professionals Recommendations : meetings should be organized in “neutral” places, in order to not influence interviewees  Italy: we did not organize the meeting in Bocconi University, nor in GPs practices. We met GPs on a Saturday, in their medical association’s base at the beginning of each meeting the meaning of the Project should be explained to the respondents, spending at least 10 minutes; then, a brief introduction of the vignettes has to be provided, paying attention not to add any comments that could somehow influence the professionals  Italy: we gave an overview of the main goals of the project and did not mention any content of the vignettes

Submission of vignettes To submit the vignettes to primary care professionals Recommendations before distributing the vignettes and questionnaires, respondents have to be asked to answer the questions autonomously, avoiding to talk with their neighbors; also, professionals have to be informed that questionnaires are anonymous and that they would have 15 minutes per vignette to answer the questionnaire after the introduction and the illustration of the rules, a paper copy of vignettes, along with the related questionnaires, has to be distributed. Please note: it is very important to distribute one vignette and questionnaire at a time it could be kind and useful to give the respondents a little present to thank them: Italy we did it and the GPs appreciated it!

Submission of vignettes To submit the vignettes to primary care professionals Other suggestions from Italian first experience: Try not to stress too much on the goal of costing the activities described in the vignettes: doctors do not love costing objectives and, most of all, they do not like to be evaluated on the basis of costs  on the contrary, try to underline the international value of the project and the extreme utility of the information they are going to give you through the questionnaires Doctors tend to ask very specific questions, especially regarding clinical details. For the sake of homogeneity, we had to describe clinical cases in general terms  try to suggest them to think to the “average” patient

Submission of vignettes To submit the vignettes to primary care professionals Other suggestions from Italian first experience: Try to distribute each questionnaire simultaneously to all the respondents of the group: if someone completes the questionnaire earlier he/she will kindly wait for the others to finish On our experience, doctors are very interested on the final results of the project  it could be useful to assure that you will provide deliverables/final reports, especially regarding PC models, overall costs of the system, quality dimensions and quality indicators.

Collection of data EXAMPLE  DATABASE for VIGNETTE 1 To collect data After the submission of vignettes is completed, each partner will be asked to summarize the information collected into a database that we will provide by early December. EXAMPLE  DATABASE for VIGNETTE 1

GANTT September October November December TRANSLATION 10th October   VALIDATION 17th October SUBMISSION 9th December COLLECTION 20th December

Next steps To measure resources consumption in the delivery of services involved in the clinical vignettes One of the most accredited methods to cost health care services/activities is the Time-Driven Activity-Based Costing (TDABC). Besides the time to carry out an activity, additional resources -e.g. drugs, tests- consumed in the management of that case will be collected through the vignettes and then monetized. We have provided guidance on how to carry out this step in the WP3 Deliverable (30th June) and we will improve the process with more details after having analyzed data collected through vignettes  Next year

Next steps To describe how certain primary care cases are managed in different systems This is an indirect achievement coming from Micro costing: we could think about how to use the valuable information regarding the delivery process of certain services

Thank you