Measuring what matters to patients:
concepts & cases

The Health Foundation

Improvement Science Development
Group
January...
Short
Answer
Value:

Gretzky Group: Health Affairs 2013

Outcomes
+
Experiences
+
Costs

2
Aim: measures to support co-production
of health* & health care in microsystems**
At risk
New condition

Clinical Microsys...
Case 1

An old story … great clinical results &
better functional outcomes …
because of functional screening
JAMA 1983
Ins...
Case 2

Using PROMs with Individuals:
Dartmouth Spine Center
Feed Forward

Referral
or Visit
Request

Orientation
&
PROMs
...
The summary report generated from patient-reported data is critical to
a physician's ability to care for a patient: same p...
Physical SF-36
Improvement

Herniated Disk
Outcomes @ 2 Years
Surgery
44 Ave Age
43% Female

Cost Per Quality
Adjusted Lif...
Case 3

•

Sweden: Rheumatology
Quality Registry (SRQ)

SRQ uses PROMs feed forward data in
flow of care: better care for ...
Dashboard for a
Rheumatology
Patient

January - March
Functional Outcomes
Clinical Outcomes
Swedish National
Quality Regis...
By the way … Swedish health system is doing better
All Patients in the SRQ, from 1994 – 2006*

Patients sicker at 1st visi...
Amy
My
Health
Status

What measures matter most to patients
at the front lines is DYNAMIC

My
Healthcare
Decisions

My
Hea...
Upcoming SlideShare
Loading in …5
×

Measuring what matters to patients: concepts and cases

776 views

Published on

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

To view a video of the presentation with sound/narrative, go to:
http://www.health.org.uk/multimedia/slideshow/measuring-what-matters-to-patients-concepts-and-cases/

Published in: Health & Medicine, Business
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
776
On SlideShare
0
From Embeds
0
Number of Embeds
211
Actions
Shares
0
Downloads
8
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Measuring what matters to patients: concepts and cases

  1. 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. 2. Short Answer Value: Gretzky Group: Health Affairs 2013 Outcomes + Experiences + Costs 2
  3. 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. 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. 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. 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. 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. 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. 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. 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. 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

×