Sonia Garca Prez, Carlos Snchez Piedra, Almudena Albertos,
Esther Arrieta, Antonio Sarra Santamera Agencia de Evaluacin de
Tecnologas Sanitarias. ISCIII. Spain Technical Efficiency of
Diabetes Management in PC in Europe. Data Envelopment Analysis 9/10
Sept 2013, Istanbul Slide 2 Background Increasng health care
expendture Incresing number of chronic patients Increasing cost of
managing chronic patients Important concern of policy makers about
the performance of the health care systems and PC in particular
Difficulty to measure efficiency/performance Which costs are
relevant? What is considered quality? Consider the system as a
whole? Slide 3 Why this study? We suggest a methodology to measure
efficiency By disease: More smple Easy to make comparsons Fnd
sources of neffcency Using time rather than cost. PC is labor
intensive, so costs are given by the time spent by professionals.
This allows comparisons across countries Data Envelopment Analyss
(DEA): Non parametrc technque used n Economcs to fnd the comparatve
effcency across Decson Makng Unts Multple nputs and outputs to
generate an effcency fronter Does no mpose a functonal form to the
effcency fronter. Flexble technque. Lttle assumptons No need for
normalization of inputs and outputs. No need for assigment of
monetary value to outcomes Slide 4 Purpose The aim of this work was
to describe the comparative levels of technical efficiency in terms
of quality and time of managing diabetes at patient level in
Primary Care systems in Europe Slide 5 Methods Databases:
EUprimecare project. Grant Agreement no. 241595 (Fnland, Germany,
Italy, Span, Hungary, Estona, Lthuana) Data Envelopment Analysis
(DEA). Output oriented program Constant returns to scale Software:
DEAP verson 2.1. Unv. New England. AU Output Proportion of
prevention activities performed last year. Composite indicator
Proportion of patients under treatment whose therapy was prescribed
by the GP Patient satisfaction. Composite indicator Input Average
time spent by GP with a diabetic patient in a year in each country
Slide 6 Average time spent by GP with a diabetic patient in a year
PC Vignettes: Answered by 27-33 GPs in each country There is a
65-year-old woman among your patients, who has been diagnosed with
type 2 diabetes. She comes in for a follow-up visit: the tests from
last week show that her HbA1c is 7%. She has no complications. She
has been taking metformin 500 mg x2. You are her main primary care
provider for the next 12 months Slide 7 Proportion of prevention
activities performed last year. Composite indicator PC users
questionnaire: Answered by 3020. Diabetic: 276 Preliminary studies
were carried out to see diferences among several types of composite
indicators (simple average, expert opinion, and PCA): Minor
differences were found Slide 8 Proportion of patients under
treatment whose therapy was prescribed by the GP PC users
questionnaire: Answered by 3020. Diabetic: 276 Slide 9 Patient
satisfaction. Composite indicator PC users questionnaire: Answered
by 3020. Diabetic: 276 Questions: Slide 10 Results CountryScore
Spain1.00 Germany0.60 Finland0.59 Italy0.47 Hungary0.40
Lithuania0.38 Estonia0.37 Slide 11 Discussion Potental new
methodology to measure effcency n PC The quality of care of
diabetic patients resulting from the time spent with the patient is
maximised for the Spanish PC system For the rest of the countries
higher intensity of outputs could be obtained Inefficiency: Large
number of administrative activities which are not translated into
direct benefit to the patient ? Referral to specialist who manages
the case ? Further investigation: Validation of these model with
more countries and for diferent diseases How these results relate
with health outcomes Find sources of inefficiency Slide 12 Thank
you!
