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Health Check-Based Preventive Care: the Global Implications of a European Study

September 15, 2013
by Mark Hagland
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The implications of the results of a recent European study for U.S. chronic care are clear

On July 15, a group of healthcare researchers published a research article, “A Standardized Vascular Disease Health Check in Europe: A Cost-Effectiveness Analysis,” which was published on the independent online research journal PLOS ONE.

The study evaluated the effects of standardized vascular health checks on expected health outcomes, and was sponsored by a collaborative initiative between the San Francisco-based Archimedes Inc., a healthcare predictive modeling vendor, and the Bagsvaerd, Denmark-based Novo Nordisk A/S.

The study found that health check strategies assessing diabetes, hypertension, lipids, and smoking over a 30-year period would likely improve health and cost-effectiveness outcomes in six European countries, including Germany, the United Kingdom, France, Denmark, Italy, and Poland.

In a press release announcing the results, Ulf Smith, M.D., Ph.D., of Sahlgrenska University Hospital in Gothenburg, Sweden, the study’s author, said, “This study using the Archimedes Model shows that offering health checks would likely reduce the 30-year incidence of major cardiovascular events including heart attack, stroke or death, and serious complications such as diabetes-related blindness and  chronic kidney disease. Based on this study, Dr. Smith said, “pre-screening strategies for treating common conditions that are increasingly becoming of concern across Europe could reduce the total budget impact of launching a health check program while leading to meaningful improvements in  health.”

The multi-faceted preventive intervention known as the health check was modeled after a program designed by the National Health Service in the UK. Using the Archimedes Model, researchers simulated a clinical trial comparing seven health check strategies to current levels of care using a simulated population of patients that matched the demographic characteristics and other risk factors in Germany, the UK, France, Denmark, Italy, and Poland.

“This study marks an exciting step forward in Archimedes’ mission to improve the quality and efficiency of healthcare worldwide, said Andy Schuetz, Ph.D., Archimedes’ director of population products and lead author of the manuscript. “In this work, we leveraged our capability to realistically model European populations and healthcare systems.”

Shortly after the publication of the study, HCI Editor-in-Chief Mark Hagland spoke with Richard Kahn, Ph.D., an Alexandria, Va.-based consultant, regarding the implications of the study’s results. Kahn is the former chief scientific and medical officer of the American Diabetes Association. He is on the faculty of the School of Medicine of the University of North Carolina at Chapel Hill. He has collaborated in the past with leaders at Archimedes on some of that company’s projects. He consults with various organizations on a wide range of healthcare projects related to diabetes, obesity, and cardiovascular disease. Below are excerpts from that interview.

When you look at the type of health check analyzed in this new study, and types of preventive care models you’ve seen developed in the U.S. healthcare systems and other healthcare systems, what would your idea of an ideal health check-based evaluative system be?

It really does speak to the project itself, which was to identify a regimen of tests that should be done to individuals prior to the onset of any disease, so as to detect nascent disease, and then move the individual into treatment, as appropriate. So in this case, we were looking at cardiovascular disease, and looking at various biomarkers, and determining what the frequency of testing should be.

Richard Kahn, Ph.D.

Is there anything in the study that would not apply to the U.S. healthcare system?

There is nothing that would not apply. But the cost-effectiveness of the various interventions varied across various countries in Europe, based on prevalence of disease, cost structures, or different healthcare systems. There may be a difference with the U.S., but my guess is if you combined the whole of Europe to the whole of the United States, there wouldn’t be much difference.

What do you see as the biggest potential for IT to support these types of processes?

By far, it is being able to individualize the treatment regimen. It would be impossible to succeed in individualizing guidelines or care without a computer modeling system. You have to do individualized risk assessment and make individualized treatment decisions, per benefits, costs, side effects, and harms, and you need analytics tools for that.

What about the linking of doctors for improved care and care management?

So the first thing you need of course is the electronic medical record. And in a system like a Kaiser, if everyone has an EMR, you can have someone in the IT department doing de=identified analyses to report back to the physicians, or an individual physician may call up their colleagues to see how everyone’s doing. So first you need an electronic medical record that everyone’s using. Then you have to convince everyone that access to that data and compilation of that data is useful. And then they need instruction and sort of “proof of principle.”

There’s real potential on the community-wide and region-wide levels for solutions like this, correct?

Oh, absolutely. If we’re really going to understand what works, we do have to understand on a community-wide level what works. And you need an EMR to capture the data; then you need people willing to capture and analyze data. But without those systems, you can never do that. And we have to be both granular and broad, in order to really find out what we need to know.

What would your advice be to CIOs and CMIOs around all of this?

The way to facilitate this is to show people its utility. The idea is to create things like case studies or practical outcomes when we do that. And if you show people what you can do with the data, people will be more willing to participate. And the next stage is to get to the analyses. But you have to add utility to it.

Is there anything else you’d like to add?

I think we do have the tools to do this now. There are certainly the electronic medical records and the analytics tools. They’re just beginning to see sophisticated mathematical models, vis-à-vis Archimedes, that are extremely well-validated, that can help us to really improve healthcare.




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