The Quality Landscape: Charting the Course for Success- Part 2: Population and Patient-Centered Care
Wednesday, December 11, 2019
Posted by: Kasia Januszewski
The Quality Landscape: Charting the Course for Success
Published December 13, 2019 on LinkedIn.com
Part 2 - Population and Patient-Centered Care
Value ultimately is defined by what individuals find useful. PCPI 2019 Conference participants discussed how developing and using new methods for consistently incorporating and quantifying patient perspectives can help refocus quality measurement and improvement on value. Among the highlights:
Achieving Health Equity through Data – “Shifting quality measurement toward individual well-being using patient-defined and reported outcomes throws into high relief long-standing disparities in outcomes among populations. These include vastly different life expectancy by race, gender and even ZIP code. Addressing these disparities is essential to improve patient care,” Renaisa Anthony, MD, co-founder and CEO of Healthy Families Project, and founder of MOMentum Park, said in her closing plenary remarks.
“Personalized data also holds the key to making health services more equitable,” Dr. Anthony added. "Equity does not mean providing everyone with the same services, but providing individuals with different challenges the support and resources they need to function well,” she pointed out.
Harnessing personalized data not only could help ensure patients receive the specific clinical services they need. Feeding data directly to patients in real time, such as home urinalysis or customized menu advice based on restaurants patients enter, through mobile devices has the potential to greatly improve clinical outcomes and lives. Dr. Anthony encouraged innovation in collecting and using data, and listening to individual patients to make progress one step at a time.
PCPI 2019 Conference Takeaway: Capturing, processing and making individual patient data available in real time can drive care and lifestyle decisions that transform patients’ lives and promote health equity.
Patient-Reported Performance Measures are Feasible – “A pilot program testing four patient-reported outcomes for chemotherapy – nausea, insomnia, pain and constipation – shows they may be useful for assessing site performance when properly validated and risk-adjusted,” said Angela M. Stover, PhD, assistant professor of health policy and management, University of North Carolina, Gillings School of Public Health.
“Early results for composite measures show significant variations by site, suggesting developing and deploying meaningful PRO-PMs is possible. Plans are underway for broader testing,” Dr. Stover said.
PCPI 2019 Conference Takeaway: Developing statistically validated condition-relevant Patient-Reported Outcome Performance Measures is not only possible, it is essential to harness patient experience to improve clinical care and outcomes.
Improving Care with Data – “Registries supporting proactive care management systems can significantly improve population health by identifying and targeting patients most likely to benefit from intensive individualized support,” said Aldo Tinoco, MD, chief health informatics officer, Veterans Health Administration.
“However, most data currently collected is designed for retrospective analysis. Capturing and integrating broader data sources in real time, including pharmacy, lab, imaging and disease screening results from electronic health records make it possible to find both high-risk patients, and patients experiencing specific care gaps. These can be used to predict which patients require extra attention, and alert clinicians,” Dr. Tinoco said.
“Outcomes and care gap data can help create a quality improvement road map for organizations,” said Shannon Sims, MD, physician informaticist for Vizient. He stressed the need for extracting data that is meaningful to clinicians and presenting it in ways that are understandable and show its clinical relevance.
PCPI 2019 Conference Takeaway: Integrating data from a wide range of sources is essential to assess and improve patient care across diverse delivery networks, and identify patients most in need of intensive support.
Mitigating Unintended Consequences –“In performance measurement, unintended consequences are inevitable and can be severe. Understanding how measures function in complex systems, and anticipating, identifying and mitigating their potential negative impact is critical for improving care,” said David Aron, MD, MS, associate chief of staff/education, co-director of VA Quality Scholars, and associate director of the VA Quality Enhancement Research Initiative Center for Implementation Practice and Research Support, Cleveland Veterans Administration Medical Center.
“When a measure becomes a target, it ceases to be a good measure,” Dr. Aron said. “For example, adopting a hemoglobin A1c target of 7.0 or less increased hypoglycemic incidents, injuries and deaths in many systems. This is because the recommendation was not based on solid clinical evidence and did not consider factors such as patient age and medications that might eliminate any benefits of a low A1c target while increase the risk of hypoglycemia. Identifying patients most likely to benefit from an intervention, and adopting continuous, rather than dichotomous, measures can help,” he said.
“Preliminary findings of a literature study of unintended consequences found gaming, increased service disparities, over treatment and increased morbidity and mortality among the most common reported. PCPI is examining how to prevent or mitigate unintended consequences in performance measure development and application,” said Courtney Hurt, MSW, project manager, Measure Development and Operations, PCPI.
PCPI 2019 Conference Takeaway: Individual clinical indicators don’t tell the whole story. Measures must be designed, applied and assessed within the context of supporting complete clinical workups and meaningful to the patient to be useful for assessing or improving clinical care.
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