In 2017, “Smarter Choices for Better Health” (SCBH) started as an interdisciplinary Erasmus Initiative. It combines insights from health science and various social sciences, in particular economics, to generate actionable results that can make health care better and simultaneously more affordable. SCBH was initiated by Erasmus School of Health Policy & Management (ESHPM), Erasmus Medical Centre and Erasmus School of Economics (ESE).
In SCBH, activities are organized in four so-called Action Lines, each one under the leadership of two Action Line leaders:
- Prevention
- Outcome-Based Health Care
- Evaluation of Health Care
- Health Equity
After a successful external review, a second round of funding has started. In the years 2022-2025, each Action Line will hire two PhD students and two postdocs in addition to the Action Line leaders already mentioned above. In each participating school several other Erasmus faculty members contribute to SCBH. Building on the results so far, together they will create a critical mass of interdisciplinary work, which can help to address challenges in health and health care and will leverage the international visibility of our university.
Call for new projects
Outside SCBH, more expertise is available at EUR and Erasmus MC with relevance for the theme “Smarter Choices for Better Health”. This concerns expertise inside and outside the three founding schools of SCBH. This open call aims to extend the current scope of the Action Lines in promising directions.
Therefore, the open call invites applicants to submit proposals for an interdisciplinary PhD project that will be partly financed by SCBH. Ideally, the PhD project will connect the current work inside an Action Line and the research in the applicant’s department. Applicants should therefore contact the leader(s) of an Action Line (see Annex 2 for more information about the Action Lines), before submitting their proposal. Note that the Action Line leaders will not be involved in the evaluation of the proposals.
The deadline for submission of a proposal is May 1, 2022, 17.00 CET.
Each proposal should be submitted as a single pdf-file to: smarterchoices@eur.nl
See Annexes 1-4 for more information.
What is SCBH’s contribution to the new PhD projects?
Selected projects will receive € 150K as a contribution towards a new full-time PhD-project with a duration of 4 years. Consequently, matching by the applicant is necessary to cover remaining salary costs and any other costs related to the proposed project, e.g., costs for travel, data acquisition or additional equipment.
How many projects will be funded?
The budget for this call is € 600K. Hence, a maximum of 4 PhD projects can be selected for funding. SCBH may fund less than 4 projects, depending on the quality of the submissions. However, individual projects will never receive more than € 150K.
Per Action Line, will only one PhD project be funded?
Not necessarily. It is possible that for an Action Line more than one PhD project will be selected for funding, depending on the quality and relevance of the applications.
Should the proposed PhD project be aligned with one or more of the current Action Lines?
Yes, the connection to one or more of the current Action Lines will be considered during the evaluation of the proposals. Applicants are therefore strongly advised to discuss their plans with the leaders of an Action Line to assess the extent of this connection and possible synergy.
Is collaboration between different faculties a requirement?
Yes, the project must be based on a collaboration between at least researchers from Erasmus MC and one faculty from EUR or between researchers from two faculties at EUR. Of course, it is possible to involve researchers from more faculties.
Who can apply?
All researchers with a permanent position at the EUR or Erasmus MC are eligible applicants. Note that researchers from ESHPM, ESE and Erasmus MC are also eligible. The main applicant does not have to be a full professor who can act as a supervisor (‘promotor’), but the application should suggest a supervisor for the proposed PhD student. The proposed PhD student must be appointed at the EUR or Erasmus MC.
What is the deadline for submission?
The deadline for submission of applications is May 1, 2022, 17:00 CET.
What is the expected start date of the PhD project?
Proposed PhD projects preferably will start on or before January 1, 2023.
Who will be involved in the evaluation of the applications?
Members of the Advisory Board and Management Team of SCBH will conduct the evaluation of the applications.
When will applicants receive information about the decision?
Applicants will be informed about the decision of the evaluation committee before June 15, 2022.
The proposal should contain the following information:
- Information about the applicant
(Name, Faculty, Department, Email, Telephone, Envisaged PhD supervisor)
- Relevant SCBH Action Line
- Abstract (max. 200 words)
- Key words (max. 5)
- Description of the proposed research (max. 1500 words), including:
- Scientific challenges involved and their relevance
- Objectives of the project
- Relevance for SCBH, and a particular Action Line
- Expected progress beyond the state-of-the-art
- Methods and techniques to be used
- Workplan and timeline
- Envisaged collaboration inside and outside SCBH
- Expected start date of the PhD student
- Envisaged knowledge utilization (max. 500 words), including
- Expected results
- Potential users
- Planned activities
- Contribution to long term collaboration inside SCBH
- Description of the hosting department (max. 500 words)
- Focus of the department
- Relevant results in the past five years
- Contribution of the proposed project to the visibility of the hosting department
Each proposal will be evaluated based on the following three criteria. Relative weights of these criteria are between brackets.
Scientific quality (40%)
Pursuit of scientific excellence is an important objective of SCBH and this should also be reflected in our choice of the new projects in the Open Call. Important attributes of this criterion, as pointed out in the call, are: clear presentation of relevant and ambitious scientific objectives, use of a suitable scientific methodology, clear potential for progress beyond the state-of-the-art and the development of original knowledge, and a track record of academic excellence of the proposers.
Leverage to other work in SCBH (40%)
While the scope of an individual PhD project as a stand-alone endeavour is limited, the project can still help substantially to bring groups of researchers together and connect distinct lines of research. The first Open Call resulted in several examples of how the PhD projects could really contribute to innovation in this respect, within the broader realm of SCBH. Obviously, to be convincing in this way, a proposal should reflect a good understanding of what goes on inside SCBH or at least what happens within the targeted Action Line and clearly outline how it intends to contribute to interdisciplinary collaboration.
Societal impact (20%)
Creation of impact beyond academic peers is an important objective of the work within SCBH. Relevant attributes of this criterion include: definition of results beyond academic papers, concrete activities to reach out to stakeholders and collaboration with non-academic partners.
Prevention 2.0
The benefits of effective prevention are widely acknowledged, but how prevention efforts should be organized is hotly debated. At the core of the debate lies a trade-off between scale and scope. Large-scale interventions typically follow a one-size-fits-all approach. Everyone is assumed to make similar suboptimal decisions about their health and they receive the exact same intervention. This leads to a narrow scope of these interventions as they cannot cater to the varying needs, preferences and contexts of individuals. Individually tailored interventions are optimized for each individual. They are complex, tackle many different behaviours, and typically involve personal coaching or guidance. However, it is unclear if and how they can be scaled up to large populations.
Prevention 2.0 has the ambition to bridge this divide. Our goal is to gain knowledge on how the effectiveness of behavioural health interventions can be improved by tailoring to (i) individual-level needs and preferences, and to (ii) environmental-level contexts, such as economic, social, cultural, and institutional factors. We plan to focus on health behaviours that are relevant to large parts of the population, associated with non-communicable diseases, and/or relatively understudied (e.g., sleep). We utilize a wide range of methodologies reflecting both the core team’s diverse background and skills, and the holistic approach taken in this action line to (re-)design effective interventions.
We identify at least three channels to address context in behavioural interventions: 1) interventions can alter the context itself, 2) interventions can be adapted to varying contexts, and 3) interventions can boost people’s decision-making capabilities to effectively manage their own context. With our interventions, we aim to respect the importance of individual autonomy and recognize that the way context is addressed should be informed by individual needs and preferences. To achieve our objectives, we plan to investigate how different contexts influence the formation of (possibly conflicting or competing) intentions and goals, how they contribute to barriers and facilitators people encounter en route to desired behaviour, and how to apply behaviour change strategies to stimulate individual autonomy. We envision that in-depth knowledge about the interaction between health behaviour and context, with individual needs and preferences in mind, will lead to sustainable interventions that are adaptive, scalable and portable.
For more information about this Action Line, contact dr. Georg Granic (granic@ese.eur.nl) or dr. Joost Oude Groeniger (j.oudegroeniger@erasmusmc.nl).
Health Equity
The difference in life expectancy between the least and most educated is around 4.5 years in the Netherlands, while the difference in (self-perceived) healthy life expectancy amounts to 13.5 years. Within the Equity Action Line we investigate how the socioeconomic and physical environment shapes inequalities in health. We do this in three ways. First, by documenting the associations between societal determinants, such as living environment, work and education, and health across the life cycle. Second, by investigating specific causal pathways within the complex interaction between societal determinants and health. And third, by evaluating interventions and policies that ultimately affect health.
Our team has extensive expertise in working with administrative and other data sources and linking these to answer complex research questions, state-of-the-art quantitative methods for causal inference, and evaluating natural and randomized experiments to identify the effects of policy-relevant interventions on health equity.
We are particularly interested in engaging in new collaborations with researchers to jointly provide a `second life’ to experiments and studies that have already been conducted. New data sets, such as the extensive administrative data available at Statistics Netherlands, and novel methodologies allow new perspectives, linking health interventions to socioeconomic determinants and outcomes over long periods of time, such as work, education, care use and health across life. We look forward to cooperating on innovative data driven research to unravel the societal causes and consequences of inequalities in health.
For more information about this Action Line, contact dr. Bram Wouterse (wouterse@eshpm.eur.nl) or dr. Bastian Ravesteijn (ravesteijn@ese.eur.nl) .
Evaluation of Health Care
The basic objective of any economic evaluation in a framework for health technology assessment (HTA) is to identify, measure, value, and compare the costs and benefits of health interventions. In recent years, the interest in valuation of the benefits of health interventions has shifted from the common health-focused quality-adjusted-life-year (QALY) model towards capturing the full benefit of interventions, by identifying additional dimensions of value beyond health. This has led to the exploration of more appropriate and broader outcome measures in terms of overall quality of life (i.e., wellbeing and the wellbeing-adjusted-life-year ‘WALY’ framework).
Against this background, research in this Action Line is based on three related pillars. The first pillar concerns measuring benefits in a WALY-way. To achieve this, a new valuation instrument (WiX) which we developed in the past years, will be validated in the Netherlands and subsequently in other countries. In doing so the additional benefit of including WALY instead of QALY in HTA decision will be quantified. It will also be determined in which sector(s) of health (in prevention, cure, and care) the benefits of using WALY instead of QALY is most substantial. The second pillar covers preferences and uptake predictions. Without appropriate uptake, potential benefits will not be realized and therefore preference elicitation studies have been conducted for decades. However, several fundamental methodological and procedural research questions remain before HTA stakeholders are able and willing to trust such study outcomes and include preferences in their policy decision making. The third pillar concerns policy-related preconditions for moving to a WALY-based decision-making framework.
The methods we use range from qualitative methods (e.g., semi-structured interviews, focus group discussions, nominal group technique) to quantitative survey methods (e.g., DCE and Likert-scales). Furthermore, we use existing data from our previous research and registries. Additionally, different analytical techniques (e.g., content analysis, theoretical analysis, direct comparisons, rankings, statistical choice modelling, validations) will be used.
For more information about this Action Line, contact dr. Jorien Veldwijk (veldwijk@eshpm.eur.nl) or dr. Raf Van Gestel (vangestel@ese.eur.nl) .
Outcome-Based Health Care
Healthcare systems are under pressure and face important challenges. Diagnostic and treatment options are expanding and concern about the rise of health spending increases. Hence, policymakers have been looking for methods and approaches to increase value for money, i.e., realizing the best possible outcomes for patients, delivered in a patient-centred way at the lowest possible costs. To achieve this, policymakers aim to reduce waste, unwarranted variation in patient outcomes and fragmentation in care delivery. Two specific focus areas that are crucial to develop adequate policies are (1) gaining insight in patient outcomes and using this information to improve quality of care, and (2) developing and evaluating reform of the incentives embedded in the methods used to pay for health care, which currently tend to reward volume instead of value of care.
Despite many efforts, insight in outcomes and their link with quality and costs of care remains limited for many diseases. In addition, knowledge is lacking on appropriate methods for quantifying and reporting outcomes and variation therein between providers. Moreover, the ‘actionability’ of aggregated outcome measures for providers to improve quality of care is being questioned. Furthermore, little is known about how outcome information can best be incorporated in alternative payment models, and what implementation of these models can achieve.
The ambition of this Action Line is to fill these knowledge gaps and thereby facilitate the transition towards better care with improved outcomes at lower costs. It aims to contribute to providing the scientific basis for this drive towards outcome-based health care. Specifically, it addresses the following two main objectives:
1. Development of methods for quantifying (between-provider differences in) outcomes, and assessment of the reliability (e.g., the role of random variation) and validity (e.g., the role of case-mix) of the resulting measures as indicators of quality of care.
2. Development and testing of feasible methods for steering on aggregated outcomes (both internally and externally) and costs – incl. benchmarking and alternative payment models (e.g., bundled payment, pay-for-performance) – and assessing their impact in terms of improvement in care processes, redesign of workflows, multidisciplinary collaboration, and quality and costs of care.
For more information about this Action Line, contact dr. Frank Eijkenaar (eijkenaar@eshpm.eur.nl) or dr. Nikki van Leeuwen (n.vanleeuwen.1@erasmusmc.nl) .