Effectiveness and Outcomes in Health Care Proceedings of an Invitational Conference (1990) / Chapter Skim
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23 Using Outcome Measures to Improve Care Delivered by Physicians and Hospitals
23 Using Outcome Measures to Improve Care Delivered by Physicians and Hospitals
Pages 201-212
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From page 201... ...
If effectiveness is to be increased, process improvement thinking must be included while constructing outcomes measurement systems. The challenge is not to create outcomes measurement systems, but to construct outcomes measurement/improvement (MI)
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~ ~ ~ - ~ ~ ~ How? Illustrated posters of health status Patient rates health Patient scores self Resource guide for clinician to prompt a regimen Benefits?
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203 oo oo o C)
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In addition to case-finding, COOP Charts can be used to monitor the overall functioning of patients with serious chronic diseases. Research suggests that the charts are able to show what impact discrete medical events, such as falls and adverse drug reactions, have on the patient's basic physical and mental function.
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From page 205... ...
The measurement strategy was based largely on the short-form general health status tools developed by John Ware and his colleagues at RAND. Two rather large randomized trials were conducted, one in Los Angeles and the other in Boston (6,7~.
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The HQT Patient Judgment System was developed by a multidisciplinary design team that included practicing physicians, hospital administrators, nurses, and quality research leaders such as Paul Batalden, Donald Berwick, and John Ware from HCA, Harvard, and RAND, respectively. The system was tested in eight hospitals in 1987 and is now in use in approximately 100 hospitals.
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From page 207... ...
Replaces nursing notes Basis for comprehensive discharge planning Better match between patient function and treatment plan Frail patient follow-up after discharge The GAP system was developed by leaders at South Shore Hospital, Carolee DeVito and William Zubkoff, with the assistance of external consultants in functional assessment such as Paul Densen and Charlotte Hamill (12~. The purpose of the GAP program is to provide a standard method of comprehensive patient assessment that will enable the hospital to improve the match of its services to the changing needs of elderly patients (13~.
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From page 208... ...
Chief among them are the following: commitment by leaders in the provider organization to foster improvement, valid and reliable measures of outcomes. systematic, repeated assessment of outcomes, easy to fit into day-to-day pattern of care delivery, ease of administration, scoring, and interpretation of measures, directly linked between outcomes measures and improvement efforts, direct benefit to individuals and groups of patients, high value placed on system's utility by patients and clinicians ability to pass information "up-line" and to aggregate it for multisite efficacy studies and appropriate comparisons, and to use measurement .
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From page 209... ...
Rather, the goal is to spot superior outcomes as a way of flagging providers who employ outstanding processes that might be adapted for use in one's own organization. Benchmarking, in my opinion, could be a powerful vehicle for improvement in health care if it is a voluntary, provider-based, "from-the-bottomup" activity.
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From page 210... ...
Functional Health Status Levels of Primary Care Patients. Journal of the American Medical Association 249:3331-3338, 1983.
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From page 211... ...
Improving Patient Functional Status: A Randomized Trial of Computer-Generated Resource and Management Suggestions. Paper presented the annual meeting of the American Federation of Clinical Research, Washington, D.C., May 1989.
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