Are we measuring the right healthcare outcomes?
For years, the healthcare industry in the U.S. has focused on quality measures established by value-based payment models. To demonstrate performance, healthcare providers have collected and reported countless clinical quality data points.
But are we measuring the right healthcare outcomes? Is the time spent on documentation worth it? Are these measures clinically relevant? Do they reflect patient-reported data and values? Healthcare is wrestling with these questions as it heads toward the next generation of outcomes measurement.
Why “Getting Rid of Stupid Stuff” resonates
One way we can make sure we’re capturing the right outcomes is to talk to people who document them day-in and day-out. Because each task adds to the workload, it’s vital to focus only on what’s absolutely necessary to improve healthcare.
In a 2018 article in the New England Journal of Medicine, Melinda Ashton, M.D., describes her organization’s effort to ease clinician burden in a program named “Getting Rid of Stupid Stuff.” Through this initiative, the health system asked employees to look at their daily documentation and nominate anything they thought was poorly designed, unnecessary or just plain stupid.
Nominations fell into three main types of documentation: 1) shouldn’t be there and is easy to remove, 2) needed, but could be more efficient, 3) needed, but users need to better understand either tools available or the “why” behind it. Dr. Ashton writes:
The Stupid Stuff program has been embraced through the organization over the past year and has extended beyond removing unnecessary documentation from the EHR…When the campaign was unveiled, it was largely met with surprise and sheepish laughter, then applause…Apparently it represents work that is important to our clinicians and other employees.
The health system received significantly more nominations from nurses than physicians. Not surprising, as nurses are responsible for more task-based documentation than physicians. As of the writing of the article, 87 requests had been completed, 75 were assigned or in progress, and only 26 were deemed not possible. The volume of requests that require adjustment demonstrates the value of taking a fresh look and critical view of current practices.
Measuring what matters most to patients
Another way to tackle this problem is to ask what are the outcomes that matter most to patients. Instead of letting payment models drive measurement, healthcare can make more progress by focusing on the metrics that patients value.
The International Consortium for Health Outcomes Measurement (ICHOM), a nonprofit organization, has developed a new approach. It envisions “a world where patients ask their doctors about meaningful outcomes, and doctors can respond with data-driven answers.”
ICHOM standards differ from typical pay-for-performance models by focusing on quality of life for patients. For example, outcomes measures for breast cancer also include depression, body image, pain and fatigue.
An increasing number of devices – wearable fitness trackers, blood pressure monitors, smart scales – are transmitting patient-reported data in record amounts, a trend that will only continue to grow. It will take substantial work on the part of health systems to capture this information and use it meaningfully to deliver better care.
Because outcomes measurement is so complex, we can’t just hard-code a health IT architecture and expect it to work as approaches continue to evolve. But flexible systems can pivot and respond every time someone asks, “Are we measuring the right healthcare outcomes?”
It’s a question we should never stop asking, and the answer will continue to evolve.