1. Does a WHO HPH Recognition Process Improve Health Service Delivery and Outcome? PHD Student Jeff Kirk Svane MA (DK) Professor Hanne Tønnesen MD PHD (DK/S) Supervisor Shu-Ti Chiou MD PHD MSc (TW) Advisor Oliver Groene MSc PHD (UK)

2. Overview Study aim and hypotheses Scope & Purpose Background Framework –WHO HPH Standards / Indicators –HPH DATA Model –HPH Doc Act Model –Other evaluated tools Project Status

3. Study aim The “WHO HPH Recognition Project” aims to: Evaluate whether a WHO-HPH recognition / certification process for HP generates –more health promotion deliveries –better health gain for patients and staff

4. Main hypotheses Hospitals departments allocated to the Recognition Process will after 1 year: –Improve health gain for patients and staff –Deliver more HP services compared to the departments allocated to the control group continuing routine clinical practice

5. Scope & Purpose Why a recognition project about HP? Clinical HP is a patient-centred approach in health care services HP Improves the effect of treatment results and contributes to improved patient safety => HP is a key dimension of quality in hospitals

6. Scope & Purpose It is THE LEADING risk factors that can be influenced by HP “(…) the three leading risk factors for global disease burden were high blood pressure (…), tobacco smoking including second-hand smoke (…), and alcohol use (…)” Among leading risk factors are also overweight, malnutrition, physical inactivity Lim, Vos, Flaxman et al. Lancet. 2012

7. Scope & Purpose Duly, HP integration is now recognized as a core issue. E.g.: Health 2020 (WHO, signed at WHA in Geneva, May 2012) Strengthening Public Health Capacities and Services (WHO, signed at RC62 in Malta, September 2012) Strategy for the Prevention and Control of Non-Communicable Diseases 2012–2016 (WHO at RC61 in Baku, September 2011)

8. Scope & Purpose So HP is core, also for hospitals and health services But Implementation in real-life is still a challenge

9. Scope & Purpose What about existing processes? Hospitals and health services implement QM, accreditation, certification and recognition But: HP is poorly included … and we dont know if it really generates better health gain?

10. Background Sparse literature on accreditation and quality improvement –1 Randomised Clinical Trials (RCT) evaluating impact of hospital accreditation on the quality of care at the national level in South Africa (Salmon JW, Heavens J, Lombard C, Tavrow P. Operations Research Results 2003;2:17)

11. What can we conclude? Better technical procedures and structure No better clinical outcome or health gain We need further studies with adequate power (sizeable sample)

12. Framework (project elements) 1.Management policy of HP 2.Patient Assessment 3.Patient Intervention and Info 4.Promoting a healthy workplace 5.Continuity and cooperation Hospitals: Useful recommendable (Groene O, Jorgensen SJ, Fugleholm AM, Garcia Barbero M. Int J Health Care Qual Assur Inc Leadersh Health Serv 2005;18:300-7.

13. Framework HPH DATA Model (St. 2) HPH Doc. HP Activities (St. 3) HPH Clinicians: Understandable, applicable & sufficient for our patients (high reliability) (Tonnesen H et al, BMC Health Serv Res 2007 + Clin HP 2012)

14. Other evaluative tools Short Form Health Survey (SF36): –Physical, mental and social conditions + 17 additional indicators –WHO HPH Standards not otherwise included (McHorney, Colleen A.; Ware, John E.; Raczek, Anastasia E. Med Care 1993; 31: 247-263)

15. Design An RCT with 2x44 hospital departments allocated to one of the two groups –Undergo the Recognition Process immediately = Intervention group –Continue their usual routine = Control group

16. Evidence degree: Pyramid In Vitro studies Animal Studies Editorial papers and Consensus (’GOBSAT’) Cases (Obs) Cohorts, Case-Control studies (Obs) CCT (intervention) RCT (intervention) Meta-analyses Syst reviews (Eccles M BMJ 1998)

17. Trial Profile Clin Dept n = 2x44 R Data collect TAU 1y 2y Data collect Site Visit & Data Val I I

18. Inclusion criteria All kinds of clinical hospital departments are eligible; from university as well as non-university clinical hospital departments

19. Exclusion criteria Palliative care departments, paediatric departments, nursing homes, non-hospital departments, and primary care facilities WHO-HPH standards and tools are not validated for these clinical activities.

20. Tailored timeline for each country Year 1 Year 2Year 3

21. Project status: Almost half way 40 out of 88 depts included: Taiwan: 21 Czech Rep: 8 Thailand: 4 Slovenia: 2 Estonia: 2 Canada: 1 Indonesia: 1 Malaysia: 1 More are coming up! (48 depts to go)

22. Overview Study aim and hypotheses Scope & Purpose Background Framework WHO HPH Standards / Indicators HPH DATA Model HPH Doc Act Model Other evaluated tools Project Status

23. Welcome! We look forward to the fruitful collaboration