using clinical outcome data to improve patient care
DESCRIPTION
This presentation by the Bureau of Health Information to the Royal Australasian College of Physicians looks at using clinical outcome data to improve patient care. It examines: Why measure and report on performance? - Accountability and quality improvement What is performance really? - It is not a measure of what the system is, it is a measure of how well the system does Whose performance is it anyway? - Attributing results to providers, units or sectors requires a careful assessmentTRANSCRIPT
Jean-Frederic LevesqueChief Executive
Using Clinical Outcome Data to Improve Patient Care
3 June 2014NSW State Office CPD Event
The Royal Australasian College of Physicians
Outline of the presentation
• Why measure and report on performance?
• Accountability and quality improvement
Outline of the presentation
• Why measure and report on performance?
• Accountability and quality improvement
• What is performance really?
• It is not a measure of what the system is, it is a measure of how well the system does
Outline of the presentation
• Why measure and report on performance?
• Accountability and quality improvement
• What is performance really?
• It is not a measure of what the system is, it is a measure of how well the system does
• Whose performance is it anyway?
• Attributing results to providers, units or sectors requires a careful assessment
Why measure and reporton performance?
National Health Performance Authority
Canadian Institute of Health InformationUK Care Quality Commission
USA Institute for Health Improvement
Ontario Quality Council
La haute autorité de santé FranceUSA Accountable Care Organisation
Quebec’s Health and Welfare CommissionerBureau of Heath Information
“I am firmly convinced that the public reporting of
information about the health system and hospital performance
is essential for the future of NSW Health.
The Garling Report
“I am firmly convinced that the public reporting of
information about the health system and hospital performance is
essential for the future of NSW Health.
It is the single most important driver (or lever) for the creation of
public confidence in the health system, engagement of
clinicians, improvement and enhancement of clinical practice
and cost efficiency.”
The Garling Report
The Bureau’s purpose
To provide the community, healthcare professionals and the NSW Parliament with independent, timely and accurate information about the performance of the NSW public health system in ways that enhance the system’s accountability and inform efforts to improve health care.
Reporting to promote accountability
• Patient empowerment
• Supporting patients’ choices and expectations
• Promotes accountability at the patient-provider interface
• Political debate
• Stimulating explicit debates about policies
• Supports a culture of openness about performance
Reporting to support improvement
• Internal motivation
• Knowing about own performance is a starting point (cognitive)
• Seeing the performance of others reinforces (mimetic)
• External pressure
• Contracts, funding streams and policies (regulatory)
• Peer judgement and public pressure (normative)
Healthcare in Focus – Annual Performance Report
Aim: takes a wide-ranging look at the NSW health system, examining performance within Australia and in comparison with other countries
Insights into Care
Aim: explores information about specific topics in patient care and identifies opportunities to improve the healthcare system
Patient Perspectives
Aim: provides information about what patients are saying about their healthcare experiences
What is performance really?
Quality of Care
Patients participation and engagementEfficiency and value for money
Adverse events and complications
Staff morale and stability
Respectfulness and dignityContinuity of care and coordination
Conformity to clinical guidelinesPerformance of healthcare
A definition of performance
Performance refers to the actual production or enactment of a function. Actors perform on stage. Athletes perform in competitions. Surgeons perform in operating theatres.
A definition of performance
Performance refers to the actual production or enactment of a function. Actors perform on stage. Athletes perform in competitions. Surgeons perform in operating theatres.
In health care systems, performance refers to the provision of expected volumes and quality of services that meets the populations needs and expectations given the amount of resources invested.
An integrated model of performance measurement
Clinically-relevant dimensions of performance
• Productivity
• Accessibility
• Appropriateness
• Effectiveness
Productivity : being organised, doing more
Productivity : being organised, doing more
Measurements of primary care volumes of services per resources invested: human and financial resources
Maximising ambulance transportation
Accessibility: healthcare where and when needed
Accessibility: healthcare where and when needed
Proportion of patients seen within a specified time after presenting to the emergency department
Proportion of people not seeking healthcare because of cost
Appropriateness: The right healthcare, the right way
Appropriateness: The right healthcare, the right way
Proportion of chronic disease patients receiving recommended care
Proportion of patients reporting not being as involved as they wanted to be in decisions about their care
Appropriateness – technically proficientMedical Errors In the past two years, have you experienced?
Appropriateness – patients’ experience of care
Effectiveness: making a difference for patients
Proportion of patients that report they were helped by the care they received
Rates of complications from surgical or medical procedures
Effectiveness: making a difference for patients
Hospitals with higher than expected results
30-Day Mortality: Mortality in hospital following discharge
Hospital profile: Dashboard
Hospital profile: in context
Policy-relevant dimensions of performance
• Efficiency
• Equity
• Sustainability
• Impact
Whose performance is it anyway?
Dashboards
Clinical and provider assessmentsAnonymised reports
Balanced scorecard
Audit and clinical competency
System and organisational perspectivesKey performance indicators and targets
Ranking of hospital facilitiesReporting on performance
Some challenges of attribution
• Performance is a nested process, enacted at the levels providers, organisational and system levels simultaneously
Some challenges of attribution
• Performance is a nested process, enacted at the levels providers, organisational and system levels simultaneously
• Performance is a shared process in a context of complex diseases management processes
Some challenges of attribution
• Performance is a nested process, enacted at the levels providers, organisational and system levels simultaneously
• Performance is a shared process in a context of complex diseases management processes
• Resources, processes and outcomes do not happen in the same timescales and indicators are limited in their capacity to capture temporal relationships
Some challenges of attribution
• Performance is a nested process, enacted at the levels providers, organisational and system levels simultaneously
• Performance is a shared process in a context of complex diseases management processes
• Resources, processes and outcomes do not happen in the same timescales and indicators are limited in their capacity to capture temporal relationships
• Outcomes are more relevant, a reflection of the ultimate goals of systems – outcomes are less attributable, results of multiple influences outside the healthcare systems
Enhancing attribution potential
• Relating measures of needs, resources, processes and outcomes to derive true constructs of performance
Enhancing attribution potential
• Relating measures of needs, resources, processes and outcomes to derive true constructs of performance
• Focusing on clinically relevant and specific measures of outcomes
Enhancing attribution potential
• Relating measures of needs, resources, processes and outcomes to derive true constructs of performance
• Focusing on clinically relevant and specific measures of outcomes
• Clustering of measures related to a specific sector
Enhancing attribution potential
• Relating measures of needs, resources, processes and outcomes to derive true constructs of performance
• Focusing on clinically relevant and specific measures of outcomes
• Clustering of measures related to a specific sector
• Controlling for confounders
• Presenting true performance by peer groups – highlighting true variations within groups/peers
• Presenting adjusted results – highlighting adjusted variations controlling for case-mix/context
Acknowledgements
• Kim Sutherland, Director, System and Thematic Reports, Bureau of Health Information
• Lisa Corscadden, Senior Researcher, Bureau of Health Information
• Efren Sampaga, Graphic designer, Bureau of Health Information
• All BHI staff