The pan-Thames paediatric intensive care consortium plans and procures inpatient and ambulance retrieval services for the residents of the Thames area.
One of the primary aims of the consortium is to optimise health gains. The Department of Health commissioning framework consultation recently opened the debate about how commissioning should evolve from a system that focuses mainly on inputs to one that measures outputs.
Although making health gains is one of our reasons for being in the consortium, we currently rely on mortality rates to monitor health outcomes. With an average 95 per cent survival rate, we are meeting international standards. But the success of the paediatric intensive care audit network has shown that there are significant differences in morbidity in the children who survive and we do not yet have a robust system to measure post-discharge health outcomes by acuity, specialty or age group.
So why are we not measuring outcomes as part of the mainstream commissioning process? What exactly is a health gain and how do we measure it?If we were able to assess and measure the well-being on admission and again on discharge against a global scale of health norms, then the difference between those two points could provide a measure of health gain.
The World Health Organisation is currently in the process of mapping international norms for child growth. The Leapfrog Group in theUS uses a range of clinical profiles to monitor outcomes three, six and nine months after discharge. By populating these profiles with data from the cohort groups, a range of norms incorporating tolerances for changes due to growth, ageing and other morbidity factors can be derived.
NHS numbers will eventually enable the tracking of each individual care pathway across providers and electronic patient records will eventually present us with the opportunity to measure individual health outcomes.
The technology and some of the tools required may already exist but we are still at the design stages in terms of health gain measurement. We are exploring further research options and would welcome any interested parties to join that discussion.