As we explored throughout this module, choosing meaningful outcomes to measure is critical. We need to set inspiring goals, and then work toward achieving those goals. Providing truly value-based health care relies on establishing and utilizing processes that systematically identify the needs and desires of our patients, and choosing the best treatment options to maximize outcomes.
To systematically measure and improve patient-reported outcomes, we need to be strategic in the creation and dissemination of patient-reported outcome measures (PROMs). Crafted appropriately, PROMs can aid in identification of outcomes that matter most to patients, help patients and their physicians decide together whether and what kind of treatment would be most appropriate for them, and extend pre- and postoperative data collection on function and well-being. While PROMs and other outcome measures have challenges associated with them, trying to provide good medical care without measuring patient outcomes has even more fundamental challenges since things that are not measured are difficult to improve.
We explored the promising work being done to improve and grow the use of patient outcome measures and thus to accelerate improvement in health care value. While Module 1 identified and discussed the many gaps in our current ability to provide value in our health care, this module began to explore the ways in which those gaps can be filled through appropriate collection and utilization of data. As we continue this journey, we’ll dive into the costs of health care and examine how costs affect health care value and the patient experience.
Here is a story from a doctor plagued by measurement of volume and revenue, rather than value and the outcomes achived with patients.
Outcomes measurement should focus on what matters to patients (and thus supports professionalism).
Patient outcomes are health outcomes ranging from standard clinical outcomes to those measuring health-related quality of life, integrating the perspective of patients and their families, access, and decision-making.
An important subset of patient outcomes is Patient-Reported Outcome Measures (PROMs). PROMs attempt to capture a patient’s sense of their own health and well-being. Resources for patient outcomes include the International Consortium of Health Outcomes Measurement (ICHOM).
Different types of measures include structure, process, and outcomes. All of these measures need to be used in conjunction to ensure we are improving care for patients.
A radar chart is an example of a tool that can be used to illustrate and compare the outcomes associated with different treatment strategies.
The UNOS case study describing changes to the national liver transplant allocation criteria illustrates the power and importance of outcomes define the goals of public policy.
WEBSITE
The Institute for Healthcare Improvement is a resource for many quality improvement tools, concepts and examples. This page details how asking the question “What matters to you?” can be powerful in improving shared decision making.
Institute for Healthcare Improvement website.
Accessed December 9, 2016.
WEBSITE
Visit the ICHOM website to learn more about the organization and view the standard sets of outcomes that matter to patients they have created for various diseases.
ICHOM website.
Accessed December 9, 2016.
ARTICLE
In this article Dr. Porter discusses value in health care, the concept of tiered outcomes and the importance of systematically measuring entire outcome hierarchies for medical conditions.
Porter, M.
New England Journal of Medicine.
December 23, 2010.
WEBSITE
Explore more about the importance of asking, “What matters to you?”, including patient examples from NHS Scotland.
What Matters to You website
Accessed December 9, 2016.