Using Clinical Outcome Data to Improve Patient Care

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This presentation by the Bureau of Health Information to the Royal Australasian College of Physicians looks at using clinical outcome data to improve patient care.

It examines:

Why measure and report on performance?
- Accountability and quality improvement

What is performance really?
- It is not a measure of what the system is, it is a measure of how well the system does

Whose performance is it anyway?
- Attributing results to providers, units or sectors requires a careful assessment

Published in: Health & Medicine, Business
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Using Clinical Outcome Data to Improve Patient Care

  1. 1. Jean-Frederic Levesque Chief Executive Using Clinical Outcome Data to Improve Patient Care 3June2014 NSWStateOfficeCPDEvent TheRoyalAustralasianCollegeofPhysicians
  2. 2. Outline of the presentation • Why measure and report on performance? • Accountability and quality improvement
  3. 3. Outline of the presentation • Why measure and report on performance? • Accountability and quality improvement • What is performance really? • It is not a measure of what the system is, it is a measure of how well the system does
  4. 4. Outline of the presentation • Why measure and report on performance? • Accountability and quality improvement • What is performance really? • It is not a measure of what the system is, it is a measure of how well the system does • Whose performance is it anyway? • Attributing results to providers, units or sectors requires a careful assessment
  5. 5. Why measure and report on performance?
  6. 6. National Health Performance Authority Canadian Institute of Health Information UK Care Quality Commission USAInstitute for Health Improvement Ontario Quality Council La haute autorité de santé France USA Accountable Care Organisation Quebec’s Health and Welfare Commissioner Bureau of Heath Information
  7. 7. “I am firmly convinced that the public reporting of information about the health system and hospital performance is essential for the future of NSW Health. The Garling Report
  8. 8. “I am firmly convinced that the public reporting of information about the health system and hospital performance is essential for the future of NSW Health. It is the single most important driver (or lever) for the creation of public confidence in the health system, engagement of clinicians, improvement and enhancement of clinical practice and cost efficiency.” The Garling Report
  9. 9. The Bureau’s purpose To provide the community, healthcare professionals and the NSW Parliament with independent, timely and accurate information about the performance of the NSW public health system in ways that enhance the system’s accountability and inform efforts to improve health care.
  10. 10. Reporting to promote accountability • Patient empowerment • Supporting patients’ choices and expectations • Promotes accountability at the patient-provider interface • Political debate • Stimulating explicit debates about policies • Supports a culture of openness about performance
  11. 11. Reporting to support improvement • Internal motivation • Knowing about own performance is a starting point (cognitive) • Seeing the performance of others reinforces (mimetic) • External pressure • Contracts, funding streams and policies (regulatory) • Peer judgement and public pressure (normative)
  12. 12. Healthcare in Focus – Annual Performance Report Aim: takes a wide-ranging look at the NSW health system, examining performance within Australia and in comparison with other countries
  13. 13. Insights into Care Aim: explores information about specific topics in patient care and identifies opportunities to improve the healthcare system
  14. 14. Patient Perspectives Aim: provides information about what patients are saying about their healthcare experiences
  15. 15. What is performance really?
  16. 16. Quality of Care Patients participation and engagement Efficiency and value for money Adverse events and complications Staff morale and stability Respectfulness and dignity Continuity of care and coordination Conformity to clinical guidelines Performance of healthcare
  17. 17. A definition of performance Performance refers to the actual production or enactment of a function. Actors perform on stage. Athletes perform in competitions. Surgeons perform in operating theatres.
  18. 18. A definition of performance Performance refers to the actual production or enactment of a function. Actors perform on stage. Athletes perform in competitions. Surgeons perform in operating theatres. In health care systems, performance refers to the provision of expected volumes and quality of services that meets the populations needs and expectations given the amount of resources invested.
  19. 19. An integrated model of performance measurement
  20. 20. Clinically-relevant dimensions of performance • Productivity • Accessibility • Appropriateness • Effectiveness
  21. 21. Productivity : being organised, doing more
  22. 22. Productivity : being organised, doing more Measurements of primary care volumes of services per resources invested: human and financial resources
  23. 23. Maximising ambulance transportation
  24. 24. Accessibility: healthcare where and when needed
  25. 25. Accessibility: healthcare where and when needed Proportion of patients seen within a specified time after presenting to the emergency department Proportion of people not seeking healthcare because of cost
  26. 26. Appropriateness: The right healthcare, the right way
  27. 27. Appropriateness: The right healthcare, the right way Proportion of chronic disease patients receiving recommended care Proportion of patients reporting not being as involved as they wanted to be in decisions about their care
  28. 28. Appropriateness – technically proficient Medical Errors In the past two years, have you experienced?
  29. 29. Appropriateness – patients’ experience of care
  30. 30. Effectiveness: making a difference for patients
  31. 31. Proportion of patients that report they were helped by the care they received Rates of complications from surgical or medical procedures Effectiveness: making a difference for patients
  32. 32. Hospitals with higher than expected results
  33. 33. 30-Day Mortality: Mortality in hospital following discharge
  34. 34. Hospital profile: Dashboard
  35. 35. Hospital profile: in context
  36. 36. Policy-relevant dimensions of performance • Efficiency • Equity • Sustainability • Impact
  37. 37. Whose performance is it anyway?
  38. 38. Dashboards Clinical and provider assessments Anonymised reports Balanced scorecard Audit and clinical competency System and organisational perspectives Key performance indicators and targets Ranking of hospital facilities Reporting on performance
  39. 39. Some challenges of attribution • Performance is a nested process, enacted at the levels providers, organisational and system levels simultaneously
  40. 40. Some challenges of attribution • Performance is a nested process, enacted at the levels providers, organisational and system levels simultaneously • Performance is a shared process in a context of complex diseases management processes
  41. 41. Some challenges of attribution • Performance is a nested process, enacted at the levels providers, organisational and system levels simultaneously • Performance is a shared process in a context of complex diseases management processes • Resources, processes and outcomes do not happen in the same timescales and indicators are limited in their capacity to capture temporal relationships
  42. 42. Some challenges of attribution • Performance is a nested process, enacted at the levels providers, organisational and system levels simultaneously • Performance is a shared process in a context of complex diseases management processes • Resources, processes and outcomes do not happen in the same timescales and indicators are limited in their capacity to capture temporal relationships • Outcomes are more relevant, a reflection of the ultimate goals of systems – outcomes are less attributable, results of multiple influences outside the healthcare systems
  43. 43. Enhancing attribution potential • Relating measures of needs, resources, processes and outcomes to derive true constructs of performance
  44. 44. Enhancing attribution potential • Relating measures of needs, resources, processes and outcomes to derive true constructs of performance • Focusing on clinically relevant and specific measures of outcomes
  45. 45. Enhancing attribution potential • Relating measures of needs, resources, processes and outcomes to derive true constructs of performance • Focusing on clinically relevant and specific measures of outcomes • Clustering of measures related to a specific sector
  46. 46. Enhancing attribution potential • Relating measures of needs, resources, processes and outcomes to derive true constructs of performance • Focusing on clinically relevant and specific measures of outcomes • Clustering of measures related to a specific sector • Controlling for confounders • Presenting true performance by peer groups – highlighting true variations within groups/peers • Presenting adjusted results – highlighting adjusted variations controlling for case-mix/context
  47. 47. Acknowledgements • Kim Sutherland, Director, System and Thematic Reports, Bureau of Health Information • Lisa Corscadden, Senior Researcher, Bureau of Health Information • Efren Sampaga, Graphic designer, Bureau of Health Information • All BHI staff

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