Outcomes in Healthcare: developing and measuring standards

The definition of health outcomes can be defined as results of care, which matter most to patients, e.g. quality of life. These outcomes should be organized around value. By value, we mean outcomes divided by cost. The goal is to achieve the best outcomes for the lowest cost, which should apply worldwide.

However, huge variation occurs globally in clinical outcomes both within and between countries, e.g. in hospital performance and in mortality rates, as does the cost of delivering services with similar outcomes.

The variation among countries on mortality

• US- factor of 2 variation between the best/worst performing hospitals for myocardial infarction (MI).
• UK- four times variation between best/worst for coronary artery bypass grafting.

The cost variation between countries (CABG, coronary artery bypass graft)

• India- 3000 dollars average cost per patient (Narayana Health)
• US- 45,000 dollars average cost (public health system)

Impact of the patient/doctor relationship

Healthcare has historically taken a ‘paternalistic’ approach, i.e. doctors make decisions on behalf of patients, not in partnership with them. A more balanced doctor/patient relationship is emerging but doctors can still overlook what matters most to the patient. For example, a surgeon who removes a prostate gland is concerned with saving the patient’s life. However, a patient’s long-term concerns include:

• incontinence
• severe erectile dysfunction

The need for a common global standard

Often outcomes are not at all measured in healthcare. When they are measured, it can be difficult to compare them especially within Europe. Different countries measure similar elements in slightly different ways and at different time points. This makes it extremely difficult to learn and improve.

In addition, there is a very strong focus on ‘process measurement’; defining process, then measuring whether or not it has been achieved. Healthcare lags behind consumer-driven industries, which have advanced with the help of the internet.

Measuring outcomes is crucial. It enables us to determine which clinics have the best outcomes and why. We can only try and learn from them once we have this data. Quality data can be used by patients to modify their behavior and to prevent or to manage their disease.

Content from GenSearch Whitepaper “Life Science Talks”