Identifying health economic competencies for quality improvement practitioners and educators: a mixed-methods study

To identify health economic evaluation competencies to guide quality improvement (QI) practice and education in Ireland.

A parallel mixed-methods design was used. A rapid review profiled the focus (cost containment, efficiency and/or equity) and purpose (education, assessment, health system improvement) of health economic evaluation competencies used in healthcare education and management. In parallel, surveys were sent to senior healthcare leaders (N=528) and quality and healthcare management scholars (N=286) in Ireland. These examined knowledge, skills and experiences of using health economics in managing quality and safety, and the perceived usefulness of proposed competencies. Descriptive statistics were generated. Literature and survey findings were integrated to refine the competencies.

Of the few competencies available from the literature, most had a multiple focus and purpose. Yet, none were focused on equity and few were used to assess competence. Of 189 survey respondents, few had received training in health economics (25%) or been involved in measurement of healthcare costs (34%), value for money (29%) or budget impact (23%). Barriers were terminology and inadequate infrastructure for linking clinical and financial data. Most (90-95%) endorsed the usefulness of proposed competencies. These were refined to form four major competencies: (1) understand the relationship between cost and quality in healthcare, (2) assess the basic costs and outcomes of a QI initiative, (3) understand and apply cost-effectiveness analysis to QI initiatives and (4) advance capacity for improvement by applying cost-effectiveness analysis to decision-making. Each major competency had four to six sub-competencies.

Health economic competencies should be integral to healthcare professionals' and managers' education and professional development.