Better Data Needed
Demand for healthcare is exploding, costs are spiralling, while the true quality picture –the outcomes patients are getting - is very variable and poorly understood.
Healthcare quality is typically reported in terms of processes like waiting times, length of stay, and discharge rates, or the success of hospitals in avoiding unintended harm, like hospital acquired infections and even death.
These factors are clearly important and need to be managed and minimised, but they do not help patients, clinicians, managers or payers understand the actual results of care being provided from the perspective of the people that matter most – patients.
The International Consortium of Health Outcomes Measurement (ICHOM) define ‘outcomes’ as "the results people care about most when seeking treatment, including functional improvement and the ability to live normal, productive lives”.
ICHOM was founded in 2014 by Harvard Business School, Boston Consulting Group and the Karolinska. They have developed Standard Sets of outcome measures for different clinical conditions that detail the questions (Patient Reported Outcome Measures or ‘PROMs’) that patients should be asked to ensure a fair comparison between different patients and groups of patients with the same condition. This allows clinicians and hospitals that treat patients with lung or breast cancer, coronary artery disease, hip and knee osteoarthritis, and many more, to collect the same patient outcomes and use it to compare themselves with others and identify opportunities to improve.
Without outcomes data, clinicians are in the dark about the true quality of care they are providing, hospitals struggle to provide care as efficiently and effectively as possible and patients lack information to make truly informed decisions.
Digital Outcomes Measurement
Digital systems for collecting PROMs that wrap seamlessly around clinical workflows and integrate with existing electronic medical records are now available. They are highly configurable to local needs to overcome implementation and process barriers to adoption and deliver real value for patients, clinicians and hospital managers alike.
Recently the private sector in the UK has introduced an outcomes measurement programme through the Private Healthcare Information Network (PHIN), and from 2018, outcomes data from patients who have undergone any of fourteen mandated procedures in the sector will be made available online to help new patients make more informed choices about their care. Some private providers, such as Spire Healthcare, are already investing in these digital approaches to meet this new agenda and go further to capture outcomes data long-term, not just the immediate results, and to give patients and clinicians access to data in real-time to enhance clinical care.
In June 2017, evidence of the survival benefit of digital PROMs measurement for patients with advanced solid tumour cancer was presented at the conference of the American Society of Clinical Oncology. In the trial, 766 patients with advanced cancer were randomised to digital PROMs monitoring during routine chemotherapy or to a comparison group undergoing usual care (without PROMs). The study group lived an average of 5 months longer than the usual care group. To put that in context, this benefit is greater than for all but one of seven drugs approved by the FDA for advanced cancer in 2016, and in a context where drugs that increase life expectancy by weeks can cost tens or hundreds of thousands of dollars this approach clearly presents a highly cost-effective additional tool in the fight against cancer.
Let’s Get On With It!
The benefits of systematically collecting and analysing outcomes data in a many conditions are now clear. Jane Maher, Chief Medical Officer of Macmillan, one of the largest cancer charities Tweeted in response to the research: "Routine collection of patient reported outcomes improves survival of patients with advanced cancer - so let's get on with it.”
We believe that very soon clinicians and hospitals treating all patients will have the outcomes data and tools they need to truly understand the quality of care they are delivering from the perspective of patients, and will therefore be able to deliver care that is higher quality, more patient-centred and greater value for all patients in the system.
Ultimately, when that happens, the aims of Boston surgeon, Ernest Codman will be realised when he wrote over a century ago: “Every hospital should follow every patient it treats, long enough to determine whether or not the treatment has been successful, and then to inquire, ‘if not, why not?’ with a view to preventing similar failures in the future.”
Dr Tim Williams is the Co-founder and CEO of My Clinical Outcomes, a technology platform that automates the collection and analysis of Patient Reported Outcome Measures (PROMs) in clinical practice. MCO is an ICHOM TechHub affiliate and is accredited in the UK by PHIN.
Tim Williams on Twitter https://twitter.com/t1mwilliams
A list of suppliers of digital outcomes tools certified by ICHOM can be found at www.techhub.ichom.org.
My Clinical Outcomes helps healthcare organisations collect and analyse the outcomes that matter to patients.
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