Effectiveness and Outcomes in Health Care Proceedings of an Invitational Conference (1990) / Chapter Skim
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18 Using Patient Reports of Outcomes to Assess Effectiveness of Medical Care
18 Using Patient Reports of Outcomes to Assess Effectiveness of Medical Care
Pages 152-159
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From page 152... ...
I illustrate several of my points using data from patients with total hip replacements and conclude with some observations that bear on the strengths and weaknesses of these measures for assessing effectiveness and outcomes in health care. LINKING PROCESS AND OUTCOME Donabedian has described three approaches to the assessment of the quality of medical care: observation of structure, of process, and of outcomes (1~.
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From page 153... ...
EARLY STUDIES OF OUTCOME Outcomes are so widely considered to be the ultimate indicator of quality that it is surprising how infrequently we analyze them carefully. In the 1830s, a physician named Pierre-Charles-Alexandre Louis started a group in Paris that discussed the use of statistics to examine patterns of medical care.
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From page 154... ...
For each patient who agreed to participate, we obtained from the medical records data on disease severity, comorbid conditions, and the process of care during the index hospitalization. Information about sociodemographic characteristics, health-related quality of life before and after hospitalization, perceived improvement in health status, health care utilization, and satisfaction with care were collected using a self-administered questionnaire mailed after discharge (2~.
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From page 155... ...
PATIENT QUESTIONNAIRE The outcome questionnaire asked about perceived general health, number of days disabled, use of health services, symptoms related to the hip replacement, current social activities, activities of daily living, well-being, satisfaction with medical care and health, whether patients thought the operation made them feel better, whether their health was better or worse than expected, whether they felt "back to normal," employment, and role functioning, as well as indicators of socioeconomic status such as education and income. The questionnaires also had questions about condition-specific outcomes.
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From page 156... ...
" I am now conducting a different study, the Picker/ Commonwealth Study of Patient-Centered Care, in collaboration with Tom Delbanco at Beth Israel Hospital in Boston, Tom Moloney at the Commonwealth Fund, and a number of other colleagues at Harvard and the Commonwealth Fund. We are collecting information from a national probability sample of about 6,000 patients nationally and 2,000 of their caregivers and asking them very
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From page 157... ...
For total hip replacement patients, however, there was a
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From page 158... ...
If one measures intermediate activities separately from basic activities, one can see a very different pattern emerge. Patients who have had a total hip replacement still show quite dramatic improvements, but there is a slightly different picture for patients who have had CABG surgery.
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From page 159... ...
A fair amount is now known about variations in certain outcomes, such as mortality, and I think the main factor that limits us at this point is a lack of understanding about the linkages among case mix, process of care, and outcomes. I would argue that if we understood these linkages better, cost containment and regulation would again become an administrative inconvenience rather than a threat to the practice of medicine as we know it today, a frequently expressed concern.
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