Measuring health outcomes is vital to improving care – yet organisations are fixated on less useful cost data. Tim Benson argues the NHS must try harder.
Although it is a basic principle of management to monitor performance against the intended outcomes, few healthcare organisations routinely monitor patients’ quality of life or the speed and completeness of recovery. Yet these are vital for patients, clinicians, providers and payers. This article looks at generic measures, which apply to patients with any combination of conditions, who are receiving any type of treatment and in any care setting, be it the home, clinic or hospital.
Using outcome measures at the point of care can help:
- identify and prioritise patients’ problems;
- improve patient-clinician communication and shared decision making;
- improve continuity of care and interprofessional handover;
- feed back on patient changes and responses to treatment;
- train new staff;
- medical audit and clinical governance.
Despite these benefits, the incentives for providing the necessary information systems are not in place. Commissioning for quality and innovation payments were introduced more than two years ago but there is little evidence that they have been used to drive the collection of outcomes data.
Information systems in the NHS mainly record events, which are measures of activity and cost, not outcome. New data collection systems that ask patients how they feel and how much they can do – such as touchscreen kiosks that patients use when checking in – are needed as well.
The capture and presentation of outcomes measurement in electronic healthcare records has been scarcely explored. Progress has been hindered by little overlap between the informatics and health outcomes research disciplines. In addition, the few existing measures were not developed for routine use at the point of care but for clinical and health service research, where volumes are fairly low and time is not of the essence.
Outcome measures contribute to patient care by improving communication between patients, their support network and health professionals, while focusing on outcomes helps clinicians attend to the issues that concern patients most.
Patients see several healthcare professionals in various domains – without continuity of the carer, continuity of care is difficult. Outcome measures are a way to share information about how the patient feels and what to do. Each patient’s progress can be tracked and trends in their quality of life assessed. Knowing what happens to other patients helps everyone understand the likely outcomes for the choices made and, as such, choose the most suitable treatment.
Monitoring outcomes is key for care providers to improve efficiency, productivity and efficacy, and optimise patient value from the given resources. Outcomes data can support negotiations with commissioners, inform strategic choices and provide evidence for defending legal actions. For clinicians and providers, routine outcomes data can be their marketing currency and strongest means of competing in the marketplace.
Commissioners need health outcomes data from providers to make informed decisions about resource allocation, health inequalities and value for money that is based on results not costs. Managed care services will use the data to help contain costs for high-risk individuals, identify individuals, stratify their risks and manage them according to suitable algorithms and care pathways. Such programmes currently put most emphasis on financial and process measures, for example reduction in hospital admission, reduced length of stay and clinical measures such as blood pressure control.
Lack of health outcomes data has prevented the maturity of commissioning and has led to perverse incentives that increase activity and costs, not better outcomes.
Success factors for outcomes measures
- Acceptable to patients, carers and clinicians
- Contributes to direct patient care by providing real-time feedback to clinicians
- Provides comparable information for management and commissioning
- Applies to majority of patients
- Is, or can be, used across different care settings (home, clinic, hospital etc)
- Sensitive and responsive to change
- Understandable, easy to interpret and clinically relevant
- Takes little time to collect as part of routine activity (seconds not minutes)
- Is consistently understood (reliable) without training
- Is independent of any specific technology platform
- Is integrated with clinical computer systems