ARTHUR KING PETERS TRAVEL GRANT PROJECT SUMMARY
Economic Evaluation of Clinics for Vulnerable Populations in France: Pilot Study of 4 Centers
"Created in 1998 by the law against exclusion, PASS (Permanences d'Accès aux Soins de Santé) are hospital-based clinics in France that provide primary care to vulnerable patients. Many of these patients come to PASS because of financial difficulties, and in certain clinics, up to 80% of the patients are migrants who experience a variety of challenges including issues with language, transportation, nutrition, and housing. During my current Fulbright year, I have been working with Dr. Claire Georges, physician and national director of PASS, on a project to examine the medical and social profiles of PASS patients based at Hôpital Saint Louis in Paris. Thus, I have become familiar with the structure and services provided through these clinics, and hope to continue my involvement with PASS through the Arthur King Peters Memorial Travel Grant.
Specifically, my objective is to launch an economic evaluation of 4 PASS clinics to assess the functionality and benefits of their services from an economic perspective. Given that existing studies on PASS are focused on the medical and social aspects of care, a study to incorporate these elements along with a discussion on the efficacy of these services may be relevant for policy makers and physicians alike. My main collaborators for the project include Dr. Claire Georges, Lise Rochaix (current Fulbright mentor and director of Hospinnomics), and Jean-Claude Dupont (deputy director of Hospinnomics).
In order to carry out my project, I have 3 main components, which I describe in detail below:
1) Initial preparation and development of study protocol: This phase of the project includes consultation with other health economists and participation in the Paris School of Economics summer program in policy evaluation, which include workshop opportunities to discuss my project (weeks of June 27 – July 1 for the micro-economics and July 4 – July 8 for macro-economics sessions, respectively). The objective at the end of this phase is to develop a clear framework for the study, including a) appropriate selection of methodology for the economic evaluation, b) detailed list of relevant data to collect from electronic patient health records for the study, including a short list of options for patient outcomes to evaluate, and c) selection of and coordination with regional PASS clinics to visit in order to finalize study measures and outcomes. Expected timeline: June to mid-July
2) Field-work in regional PASS clinics: This phase of the project includes approximately 1-week visits to three other PASS clinics outside of the Ile-de-France region for an incorporation of 4 total centers for the economic evaluation (the first week of the project will begin with the PASS at Hôpital Saint Louis, Paris). Each visit will consist mainly of meetings with directors and staff to understand general characteristics of patients at their clinic (with regard to demographic information and medical conditions) and to obtain access to patient health records. Observations of consultations will also be conducted if time allows to aid in determining standard patient outcome measures that can be evaluated across all 4 centers. Expected timeline: mid-July to mid-August
3) Data collection and analysis: After the regional visits, consultation with Dr. Georges and other collaborators will finalize the outcomes to use in assessing patient outcomes across all 4 centers. Given that the study framework had been established and that access to data have been obtained for each site during my field visits, the final steps consist of data compilation, cleaning and analysis according to the study protocol. Expected timeline: mid-August to mid-September
The results from this project will provide information on the efficacy of services delivered within 4 PASS centers. Given that I am hoping to continue my research for a second year in Paris, there is a high possibility to build upon this project in expanding the economic evaluation methods pioneered in our pilot study to all PASS centers in France, thus allowing for an economic evaluation of the effectiveness of their services at the national level."