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Measuring what matters to patients: concepts and cases


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This presentation, by Professor Eugene Nelson from the Dartmouth Institute, looks at measuring what matters to patients and some specific case studies and examples. …

This presentation, by Professor Eugene Nelson from the Dartmouth Institute, looks at measuring what matters to patients and some specific case studies and examples.

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  • 1. Measuring what matters to patients: concepts & cases The Health Foundation Improvement Science Development Group January 7, 2013 Eugene C. Nelson, DSc, MPH The Dartmouth Institute Dartmouth-Hitchcock Health System Wayne Gretzky Acknowledgements: J. Weinstein, R. Reid, S. Lindblad, J. Wasson, C. Kerrigan, J. Kirk, P. Batalden, et al and financial support from The Dartmouth Institute, The Dartmouth Center for Healthcare Delivery Science, the Robert Wood Johnson Foundation, PCORI and NIH-NIA.
  • 2. Short Answer Value: Gretzky Group: Health Affairs 2013 Outcomes + Experiences + Costs 2
  • 3. Aim: measures to support co-production of health* & health care in microsystems** At risk New condition Clinical Microsystem Recover/Reduce Burden Person Co-Production Clinician Key Patient Outcomes Experience Function Disease Key measures Risks Costs Competence Health Determinants* • Genetics • Environment • Lifestyle • Health care ** Clinical microsystems, i.e., the place where patients and providers meet and interact for the benefit of patients (12)
  • 4. Case 1 An old story … great clinical results & better functional outcomes … because of functional screening JAMA 1983 Insert JAMA article x Jack Kirk, MD Founder Dartmouth COOP Project 4
  • 5. Case 2 Using PROMs with Individuals: Dartmouth Spine Center Feed Forward Referral or Visit Request Orientation & PROMs Acute Care Management Initial Work Up Plan of Care Chronic Care Management Functional Restoration People with healthcare needs Palliative Care Functional & Risk Status Disease Status Expectations For Good Care Sunk Costs Feedback  Improvement registry  Public reports website  SPORT & research © 2000, Trustees of Dartmouth College, Batalden, Nelson, Wasson People with healthcare needs met Functional & Risk Status Experience Against Need Disease Status Incremental Costs 5
  • 6. The summary report generated from patient-reported data is critical to a physician's ability to care for a patient: same page care Functional Status Red Flags Risk Status “practicing without it …flying a plane without instruments” Disease Status History & Symptoms Patient Perception of Outcomes
  • 7. Physical SF-36 Improvement Herniated Disk Outcomes @ 2 Years Surgery 44 Ave Age 43% Female Cost Per Quality Adjusted Life Year Added By Surgery $34,355 Non-Surgery 30 Ave Age 45% Female 44 30 My risk calculator Functional Clinical Reduced Oswestry Symptoms 1.64 QALY 1.44 QALY $74,870 $34,355 -25 Moving research results back to patient care … risk calculator used at point of care for Shared Decision Making about likelihood of outcomes based on different treatments 78% Satisfaction -37 Satisfied With Improvement 59% Costs $13,108 $27,341 Total Direct & Indirect Costs
  • 8. Case 3 • Sweden: Rheumatology Quality Registry (SRQ) SRQ uses PROMs feed forward data in flow of care: better care for individuals, practice improvement, new care models, retrospective & prospective research & better measured outcomes for Sweden RA patients Staffan Lindblad, MD 8
  • 9. Dashboard for a Rheumatology Patient January - March Functional Outcomes Clinical Outcomes Swedish National Quality Registry … patient is doing better … N of 1 experiment… Responded to biologics June - December
  • 10. By the way … Swedish health system is doing better All Patients in the SRQ, from 1994 – 2006* Patients sicker at 1st visit From front line practice to national policy Patients better at 12 months *Black line shows DAS at initial visit and blue after 6 months and turquoise after 12 months.
  • 11. Amy My Health Status What measures matter most to patients at the front lines is DYNAMIC My Healthcare Decisions My Healthcare Plan My Health Outcomes Patient Reported Metrics + Clinical Metrics = Guidance System for Getting It Right … •Health care decisions right for Amy •Health care plans right for Amy •Health care outcomes best for Amy •Thus, Amy is able to co-produce her care 11 Case 4