11/29/2016

Using the Evidence Graph to capture argumentation about health decisions.

Decision frameworks are tricky, and healthcare value assessment frameworks are no exception. While they can provide objectivity and support decision quality, they can also smother innovation and prevent some patients from receiving needed care. US pharma industry groups have reacted strongly to the framework used by ICER, the Institute for Clinical and Economic Review. This post recaps their argument and shows how to capture it using PepperSlice.

These screen grabs show how to visualize an argument as an Evidence Graph. Think of each node pair as a relationship. Example: ICER framework lacks Transparency.

Click any line on the graph to list supporting evidence for that relationship. All PepperSlice content is available as a searchable, reusable inventory of evidence-based insights.

Evidence Graph in PepperSlice

Evidence Graph with Details

 

PepperSlice content is also viewable as bite-size, top-line written summaries (Slices), as shown here. Each Slice corresponds one-to-one with a relationship on the Evidence Graph. Grouping Slices together captures an entire argument, such as this one about potential weaknesses in the ICER decision framework.

  ICER_header

ICER_Slices

 

For your reference, here's a conventional, long-form review of the pharma industry criticisms of ICER's framework.

ICER triggers response. For more than a year, ICER has used a new value assessment framework to guide its evidence reports on new drugs and other interventions. Major industry groups have challenged the readiness of that framework, questioning its appropriateness in several areas. Now ICER has requested stakeholder comments in preparation for a 2017 revision.

NPC (the National Pharmaceutical Council), PhRMA (biopharma trade group), and AMCP (the Academy of Managed Care Pharmacy) have significant concerns about ICER’s methodology. In particular, they take issue on:

Real-world evidence. NPC says "ICER [should] have a clear process for managing the evolution of evidence, especially in the case of emerging therapies.... [T]hese reviews will continue to be relied upon by other stakeholders even after additional data (e.g., real-world evidence) emerge." And AMCP suggests real-world evidence and patient-reported outcomes should be "re-examined to further enhance the utility and relevance of the value assessment framework."

Budget impact. ICER should not confuse budget impact with value. "Budget impact assessments — which are measures of resource use, not of value — should remain completely separate from value assessments," says NPC. And this from PhRMA: ICER should suspend "the use of budget impact estimates until more sound methods are developed and validated."

Economic model transparency. The information provided is "not sufficient to enable reviewers to reproduce the results and provide meaningful, real-time input. Full transparency — down to the equation level — is needed to enable reproducible results and support fully informed stakeholder collaboration." NPC asks that ICER release the model to all stakeholders.

QALY. PhRMA asks for "Adjustment of the cost-effectiveness component of the framework to reflect the inherent and widely recognized limitations in traditional quality adjusted life years-based cost-effectiveness analysis (CEA), including capturing a wider range of benefits in CEA and presenting a range of care value estimates based on sound assumptions and varied approaches."

Other highlights:

NPC: To guide future development, NPC published a set of Guiding Practices for Patient-Centered Value Assessment. Dan Leonard recently recapped NPC's viewpoint on how frameworks should be developed.

PhRMA: Four specific recommendations are offered, intended to move ICER in a more "methodologically rigorous, patient-centered direction". They request significantly more transparency into how it works with stakeholders. And they offer specific advice on How to Get Value Assessment Frameworks Right.

AMCP: The pharmacists' group expresses concern that the current framework "lacks a process for incorporating real-world evidence (RWE) and patient reported outcomes (PROs) into the catalog of evidence that informs the underlying economic models. [Doing so would] better represent the patient experience."

Version 2.0. In October, ICER convened a broad group of stakeholders to inform its planned update. Invitees included people from pharma, academia, payers, patient advocates, and trade groups. A revised framework will be posted for additional comments next month; ICER's 2.0 version will likely become final in early 2017.

What's next for value frameworks? ICER is only one of several frameworks gaining traction in healthcare. To help establish best practices going forward, the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) has launched an initiative on US value assessment frameworks; more than 250 people attended the kickoff stakeholder meeting. A task force is preparing a policy white paper on the appropriate definition and use of value assessment frameworks, expected Q1 2017. ISPOR is the sole funder of the effort.

 

11/10/2016

Guide: Promoting Evidence-Based Insights

Ugly Research, the producer of PepperSlice, offers a new guide, Promoting Evidence-Based Insights. Intended for PepperSlice users, the guide explains how to shape your content around four essential elements: Top-line, evidence-based, bite-size, and reusable. It's suitable for people in marketing, R&D, analytics, or advocacy.

Show how A → B. So people don't think tl;dr or MEGO (My Eyes Glaze Over), be sure to emphasize insights that matter to stakeholders. Explicitly connect specific actions with important outcomes, and provide a simple visual. Be succint; you can drill down into detailed evidence later.

The insights guide is free from Ugly Research.

Promoting Evidence-Based Insights

09/21/2016

Build an evidence-based strategy with a Strategy Board.

Strategy Board on PepperSlice

The PepperSlice Strategy Board type is an easy way to show how strategic outcomes map to influential factors, with supporting evidence one click away. Oftentimes people create diagrams or maps to illustrate a strategy: Typically these show primary goals, along with factors that influence the desired outcomes. In PepperSlice, you can do something similar, but with an important distinction: The evidence establishing each relationship is rigorously identified.

Here's how it works. As shown in the simple example above, the Strategy diagram illustrates relationships such as the connection between employee development and the goal of business growth. The various factors ultimately connect to one or more fundamental strategic objectives (business growth in this illustration).

Slicer tip: Do you prefer a simple graph of the data? Use the Evidence Graph Board type instead.

View the evidence underlying any particular relationship by clicking on the line. This example shows how employee development is being connected to business growth. The idea is to give people a way to build an evidence-based strategy that is transparent to all stakeholders.

 

Strategy diagram with evidence in PepperSlice

 

Steps for creating a Strategy Board:

-Select Strategy as the Board type for a new or existing Board. Optional: Label one or more of the four sections that will display on your Strategy diagram. 

-Create or locate Slices that describe factors influencing your organization's strategic outcomes. Pin those Slices to your Strategy Board.

-The Strategy diagram will display automatically. Drag individual nodes to the desired position; the layout you specify will autosave.

Slicer tip: Node labels correspond to the 'Relationship' labels that are entered when each Slice is created. For example, the employee development Slice specifies this Relationship: employee development ➞ increase ➞ business growth, so those two factors appear as the associated node labels on the Strategy diagram.

View this example Board in PepperSlice ('Managers can influence several factors essential to growth').

09/07/2016

Evidence graphs: Visualizing insights in PepperSlice.

In PepperSlice, you can browse through Slices to see people's insights, along with their supporting evidence. The Evidence Graph is another way to view this data. Shown here is the Evidence Graph for a Board about management factors influencing business growth. It's an easy way to see data relationships, with supporting evidence one click away.

Evidence graph in PepperSlice

 Slicer tip: Do you prefer a strategy map-style presentation? Use the Strategy Board type instead.

Review the evidence underlying any particular relationship by clicking on the line. This example shows how employee development has been connected with business growth.

Evidencegraph_management_evidence

To create an Evidence Graph:

-Select the Evidence Graph Board type for a new or existing Board. Slicer tip: Board type can be changed anytime.

-Create or locate Slices that tell the story for your Board, and pin them to it.

-The Evidence Graph will display automatically. Drag individual nodes to the desired position; the layout you specify will autosave.

Slicer tip: Node labels correspond to the 'Relationship' labels that are entered when each Slice is created. For example, the employee development Slice specifies this Relationship: employee development ➞ increase ➞ business growth, so those two factors appear as the associated node labels on the Evidence Graph.

View this example Board in PepperSlice ('Managers can influence several factors essential to growth').

Enjoy your visual search for insights and evidence.

08/17/2016

Weighted evidence, plus drag and drop.

Drag & Drop. Rearrange the Slices on a Board by simply dragging and dropping them into the order you want displayed. Typically, people place the evidence they want emphasized in the first (left-hand) position.

New feature drag and drop


New Board type: Weighted Evidence. When presenting Slices on a Board, now you can rank them to indicate their relative weight or importance. Decision makers will immediately see which evidence is highest priority. (Think of this as a light version of multicriteria decision analysis, where deciding factors are ranked.)

weighted board example

- To begin, set Board Type to Weighted Evidence. (Note: Board Type can be changed at any time.)

- When first added to a Weighted Evidence Board, each Slice displays "Weight%". Click to enter a % for each Slice (0-100), making sure the Board totals 100%.

- Your Slices will display in decreasing % order.

weighted board example

06/14/2016

PepperSlice features: following and placeholder images.

Two new PepperSlice features this week:


Follow people in PepperSlice1. Following people.
Now you can follow other Slicers, so it's easier to keep up with what your colleagues are doing. To follow someone: Click their screen name to display their profile, and click Follow.
 
To see who you're following: Select People in top menu --> People you follow.

To see who's following you: Select People in top menu --> People following you.
 


Slices of Peppers2. Placeholder images.
Now you can create a Slice without having an image ready to go. If you create a Slice without providing an image, a randomly selected placeholder will display. Replace it anytime by editing your Slice.