Refocusing care on outcomes patients care about
MedWire News: What a concept: base healthcare decisions on outcomes that matter to patients.
It sounds like a pipe dream in an era of miserly budgets and limited resources, but creating systems of care that focus on providing patients with meaningful outcomes - such as helping them to spend more time at home following a discharge - can meet the dual goals of maintaining high-quality care at an acceptable cost, writes cardiologist and healthcare executive Thomas Lee in The New England Journal of Medicine.
To meet their system-wide goal of improving the value of care as seen from their patients' points of view, Lee and colleagues at Partners Community HealthCare, Inc. in Boston, Massachusetts, have implemented strategies that include measurement of outcomes and costs during "meaningful episodes of care" rather than evidence-based processes.
"Available measures may never adequately capture 'what matters to patients,' but measures improve fastest when they are being used," writes Lee. "So the care-redesign process should not grind to a halt until ideal measure sets are found. Measurement and reporting with currently available data should begin immediately, with the explicit understanding that reports are going to keep on coming indefinitely. The implied message is this: since the data will be impossible to ignore, we might as well make them better."
Instead of looking at single events such as tests, procedures, and patient visits or stays, healthcare systems can choose to measure outcomes and costs as a routine part of care.
" The effective pursuit of this goal demands that providers organize around patients' needs, - first identifying segments of the patient population who have similar needs (often defined on the basis of diagnoses or arrays of medical and socioeconomic conditions) and then figuring out how to meet those needs systematically. If we become better at meeting patients' needs, the outcomes that matter to them should improve, as should our efficiency in achieving them," says Lee.
He cites, as an example, how his system measures outcomes among ischemic stroke patients treated in three of the hospitals in the network currently using the strategy, which includes Boston's Massachusetts General Hospital and Brigham & Women's Hospital. Although all three hospitals had 30-day readmission rates of 8.9%, there were substantial variations among them in all-cause mortality rates, emergency department visits within 30 days of discharge, and observed mortality within 30 days of discharge.
"The Stroke Team also realized that we don't reliably capture information regarding other outcomes, such as continence and mobility, that are important to patients who have had a stroke, so we may not notice when these outcomes are worsening," he writes.
The team's recommendations for changes include improvements to scheduling and navigation of the system for patients, use of data and guidelines to reduce unnecessary resource use, patient monitoring over time, and implementation of strategies to reduce adverse clinical events, emergency department visits and readmissions, and medication errors.
By Neil Osterweil, MedWire Reporter