Published: 14/07/2005, Volume II5, No. 115 Page 21
Patient-measured outcomes offer the best information to support choice, believes Andrew Vallance-Owen
Health secretary Patricia Hewitt has signalled the reform agenda will continue with a doubling of the number of operations commissioned in the independent sector, and choose and book coming soon. But how, then, will patients be helped in making the right choice of hospital or doctor for their needs?
When the Care Standards Act was passed, tight regulations and minimum standards were brought in for the independent sector and it is only quite recently that a similar approach has been adopted for the NHS, albeit with a rather lighter touch.
Patients, then, can choose independent sector hospitals or treatment centres secure in the knowledge that they and the clinicians that work in them are well regulated.
But regulation can only enforce a minimum standard and mostly covers process.
Activity rates might be helpful in giving an idea of the experience of the clinical teams, systematic use of clinical pathways can ensure an evidence-based and consistent approach to treatment, and patient satisfaction surveys can help in showing how patients felt about their care. But what could really help in quality differentiation is operational data on clinical outcomes.
Traditionally, most hospitals have collected outcome data, but this has practically always measured problems or failure of one sort or another.
Mortality is the best known, perhaps because it is comparatively easy to define, and much has been made of differing mortality rates by companies like Dr Foster that produce excellent analysis of standardised mortality rates.
This is very valuable for patients going for open heart surgery where death is a well-known complication, but not very helpful or encouraging for patients having more-routine operations like hernia repairs.
Other data of this type includes unexpected re-operations or readmissions, adverse incidents and, of course, infection rates. This type of information is extremely important to clinicians and much can be learnt from it, but how helpful is it to patients trying to make a choice of the best place to go, rather than the worst place not to go?
We believe the routine collection of patient-measured clinical outcomes is the way forward and we have been gathering this type of data for surgical interventions in our hospitals for some time. The great thing about it is that the data mostly shows health gain - ie success rather than failure. The data is easy to collect by procedure, unit and clinical team and gives a good idea of where good clinical practice can be found.
To date we have used the data internally to encourage continuous quality improvement by feeding it back to hospitals and clinicians on a regular basis.
In future, we need to support patient choice by giving people more information. A MORI poll we did found people wanted choice in healthcare, but 80 per cent wanted to work with their GP in making their choice. So providing comparative data to GPs would be a first step. A perhaps more controversial use of data like this is to help measure productivity.
Healthcare Commission chair Professor Sir Ian Kennedy has stated that the commission will seek to use 'intelligent information'. Outcome data must fall into this category. So in patient-centred healthcare its use should be encouraged, preferably after agreement has been achieved on which tools to use so that sensible comparisons can be made.
We look forward to the day when we can benchmark our data with that of other hospitals and really enable informed choice for patients in this country.
Dr Andrew Vallance-Owen is group medical director at BUPA.