Why measure outcomes

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About Health Catalyst. Investor Relations. Article Summary The healthcare industry is currently obsessed with outcome measures — and for good reason. Process Measures Are Important. Determining Root Cause to Solve the Problem. Using Process Measures and Reducing Variation.

First it helps to understand the three types of measures we use in healthcare analytics: Outcome measures: These are the high-level clinical or financial outcomes that concern healthcare organizations. They are the quality and cost targets you are targeting for improvement. These measures are often reported to government and commercial payers. Some examples of metrics for outcome measures include mortality rates , readmissions rates , and surgical site infection rates.

The hospital wants to reduce LOS and save money. The balance metric might be patient satisfaction. If mothers feel rushed toward discharge, the outcome there might be a negative impact on patient satisfaction even while improving LOS. Process measures: These measures are the specific steps in a process that lead — either positively or negatively — to a particular outcome metric. UTMB reduced their hospital readmission rate by implementing several care coordination programs and leveraging their analytics platform and advanced analytics applications to improve the accuracy and timeliness of data for informing decision making and monitoring performance.

Patient-reported outcome measures PROMs fall within the patient experience outcome measure category. This information can provide a more realistic gauge of patient satisfaction as well as real-time information for local service improvement and to enable a more rapid response to identified issues. Patient experience may also be used as a balance metric for improvement work. For example, a care delivery process may decrease the LOS, which can be a positive outcome, but result in a decreased patient satisfaction score if patients instead feel they are being pushed out.

Given the rapid changes that occur within healthcare, making sure best practice care guidelines are current is critical for achieving the best care outcomes. Failing to adhere to evidence-based care guidelines can have negative consequences for patients. Timeliness of care outcome measures assess patient access to care. Overcrowding in the emergency department has been associated with increased inpatient mortality, increased length of stay, and increased costs for admitted patients.

A community hospital system implemented an improvement process to address overcrowding in its ED after determining that approximately 4, patients were leaving its ED each year without being seen. They leveraged their analytics platform to develop an ED analytics application that provided actionable, timely ED performance data to focus improvement efforts on four areas: staffing patterns, registration, triage assessment by the registered nurse, and early access to a qualified medical provider.

They achieved significant performance improvements, including an 89 percent relative reduction in the rate of patients that left without being seen, with current performance at 0. The efficient use of medical imaging is an increasingly important outcome measure. Using its EDW to examine real-time X-ray data, it realized clinicians were ordering chest X-rays for 65 percent of their asthma patients—evidence-based practice calls for X-rays in only five percent of cases.

Achieving outcomes is important, but the process by which health systems achieve outcomes is equally important. Process measures capture provider productivity and adherence to standards of recommended care. For example, if a health system wants to reduce the incidence of skin breakdown, then it might implement the process measure of performing a risk assessment using the Barden Scale for reducing pressure ulcer risk in all the appropriate units in the hospital.

If health systems are too focused on an outcome, then they lose sight of the process. The following outcome and process measures illustrate how systems can improve healthcare outcomes by improving processes:.

As health systems work diligently to achieve the Quadruple Aim, they need to prioritize three outcomes measurement essentials: transparency, integrated care, and interoperability. Used in tandem, these essentials improve and sustain outcomes measurement efforts by creating a data-driven culture that embraces data transparency, an integrated care environment that treats the whole patient and improves critical care transitions, and interoperable systems that enable the seamless exchange of outcomes measurement data between clinicians, departments, and hospitals.

Healthcare is on a journey to outcomes transparency. However, in the example of tibial plateau leveling osteotomy TPLO or hip replacement, it is:. Process of recovery. Outcomes relate to the nature of the care and recovery. The level of discomfort during care and how long it takes to return to normal activity matter greatly to patients.

In the example of TPLO or hip replacement, it is:. Outcomes related to sustainability of health. Sustainable health outcomes here would be:. Outcomes are a powerful force to improve transparency and the satisfaction of doctors, not just patients and owners. Measuring and reporting outcomes is crucial for learning and improving care over time.

By comparing their performance with peers inside and outside their organization, the care team can advance and thus positively impact outcomes. Furthermore, outcome improvement is a powerful driver for lowering costs and hence improving value.

These dogs would likely return to normal activity more quickly and have a better QOL. In the tibial plateau leveling osteotomy example, the improved asepsis protocol will lead to less infections hence improve antibiotic stewardship. Measuring outcomes that matter to patients or their owners is not an easy task, and progress has been slow. Aside from survival, outcome measurement remains limited.

The tendency is to measure only what the care team directly controls in a particular intervention, what can be measured easily, or the intervention and treatment that can be billed. Furthermore, rather than determining outcomes for the full care cycle over which value is determined, outcomes are assessed for department or billing units. In health care, outcome work often is driven by medical specialty experts or consensus panels, and not multidisciplinary groups for medical conditions.

Lack of an electronic medical record system that could effortlessly capture outcome data and compile it remains a challenge for many health care systems. It is paramount for all stakeholders involved in patient care to come together in creating a process for agreeing on a minimum sufficient set of outcomes for each medically important clinical condition and to standardize those measurements nationally and internationally.

Once that happens, the care team will be able to collect and share data on outcomes in an efficient manner, which in turn will allow comparisons, ultimately improving care. The standards created by ICHOM are helping doctors, patients, and information technology vendors to achieve a common ground with respect to what needs to be tracked, making implementation of outcome measurement easier and more efficient.

Such a complex endeavor requires the cooperation of multiple players, and hence it will take time to occur. If, as veterinarians, we want to improve the value provided to our patients and their owners, as well as bettering ourselves, VBVC could be an interesting path towards improvement. The aim of doctors and veterinarians is not only to save lives but also to improve the lives of patients. Doctors' understanding of the effect of disease and treatment on patients' daily lives is poor.

They should only be used for reporting observable concepts eg, signs, behaviors and cannot be validly utilized to assess signs pain or other unobservable factors. However, these measures are not outcomes that are necessarily perceived as important by pet owners.

For example, in human medicine, surrogates reporting pain are likely to report less pain than the affected individuals themselves. Despite challenges, the use of PROMs is viewed as an integral part of the future of health care. Technology, if not properly implemented, will be a barrier, and thus strong information technology support is critical.

Despite the fact that many different PROMs exist in health care, there is still a lack of consensus regarding which 1 would be better suited for many conditions. Groups such as ICHOM have made strides encouraging agreement around a single set of measures for a particular clinical condition.

Proper development and deployment of these measures in veterinary clinical practice would advance our understanding and reporting of outcomes, a key aspect of VBVC. A crucial aspect of VBHC is to organize the health care team around the patient's medical condition, departing from the traditional way of organizing by specialization or service department. The complexity of health care delivery cannot be addressed by any individual or organization acting in isolation. Care is often poorly coordinated among clinicians within and across settings, and the increase in specialization further adds intricacy to the system because of the involvement of multiple doctors.

When multiple doctors participate in the care of patients in a silo, accountability for patient care gets blurred. This leads to a fragmented system where coordination and communication among doctors and patients is difficult. This lack of continuity of care endangers patients worsens outcomes and increases waste increases costs.

Doctors must work with patients to help achieve the outcomes most important to patients. Clinicians at different points in the treatment pathway must come together in interdisciplinary teams to create more integrated and customized interventions.

This approach implies an upfront cost participating professionals' time , but this team consensus leads to better care because patients are treated correctly, thus eliminating unnecessary and ineffective care. Humans with heart failure showed improved outcomes and quality of care when their treatment was delivered in a collaborative way between generalists and cardiologists.

Society's relationship with animals is changing, likely influencing the medical care that owners desire for their pets and contributing to the increase in veterinary patients for which care includes referral to a specialist. Pinnock, C. Aisenbrey, J. What health care leaders need to do to improve value for patients.

Journal Articles. What is Value in Health Care? Larsson, S. Standardizing patient outcomes measurement. Genesis of a Standard Set. Making it Happen.