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Conference explores outcomes imperative in improving health care quality
By Celena E. Kusch
Since the 1980s, total quality management, or what Penn State calls continuous quality improvement, has revolutionized business processes in manufacturing and industry. Encouraged by these successes, organizations from government and education to service industries and health care have adopted the quality improvement model in growing numbers. During the Outcomes in Health Care Data conference held at The Penn Stater Conference Center Hotel last summer, nearly 100 clinicians, medical researchers, health care administrators and faculty and other health professionals discussed ways to implement and evaluate performance measurement in health care.|
Conference speakers and panel presenters represented medical centers, health care providers and universities from across the nation.
Our goal was to serve people in health care organizations, including providers and health plans, as well as state and local policy makers, Dr. Pamela Farley Short, professor of health policy and administration at Penn State and conference chair, said. Today, many of us are being barraged by information and demands related to outcomes. Most people in the health care field know that outcomes are important, but it is easy to imagine that many are unsure about how to measure and act on outcomes data.
The conference filled in those gaps in information at two levels, Short said. First, it provided a big picture overview of what we mean when we talk about outcomes, what outcomes can do for us and what limitations we find in using outcomes. Second, it offered workshops that examined the details of outcomes management. Many of our speakers represented organizations from around the country, and they discussed their experiences with measuring and working to improve outcomes. The conference provided a lot of information about what outcomes are and examples of how they can be used.
According to Dr. Frederick Orkin, professor of health services research and anesthesia at The Milton S. Hershey Medical Center, quality improvement implies a valuable change over time that can be measured by comparisons of outcomes before and after alterations to processes are implemented. Increasingly for the health care industry, he pointed out, value must be measured through the experience of patients, as well as health care providers. In the past, we defined quality as fitting the providers concerns, but that is not germane to the climate of health care today.
Outcomes data include clinical results, as well as effects related to quality of life, patient satisfaction and cost, but these measurements do not have to be subjective, Orkin continued.
There are a number of instruments for measuring changes in quality across populations. The survey instruments must be relevant, reproducible, precise and valid, and they are out there for us to use, Orkin added.
For the conference keynote speaker, Dr. Robert Brook, vice president and director of the RAND Health Program, the possibilities for improvement are endless. His address Will the Quality of Health Care be any Better in the Next Century? asked conference participants to take a close look at the current status of health care quality and to create a vision of quality and service for years to come.
Brook described a visit to the doctors office of the future where, instead of leafing through waiting room magazines, patients complete an interactive electronic survey. Viewing images and reading detailed descriptions, patients answer questions to generate a current health profile and medical history.
Once in the examination room, Brook imagined, patient and doctor examine the survey results together on an electronic whiteboard. After a physical examination, the doctor adds entries and diagnosis to the interactive chart. Tapping into a national or worldwide medical research database, the doctor requests the most up-to-date clinical trials, treatment recommendations and prescription information, including interactions with other prescriptions in the patients file.
Through both automated and physician follow-ups, the outcomes of treatment are added to the patients chart and become part of a dynamic medical research database for tracking treatments and complications. By using technology to scale up the numbers of patients involved in medical research trials, Brook argued, clinical research will improve.
People over 65 are almost never included in randomized control trials, Brook explained, but research that relies upon information systems will be able to provide medical data that includes these populations.
Orkin agreed. As data collection becomes a routine part of care, he predicted, clinicians will be developing a new scholarly activity for physicians in health care centers. I am hopeful that as we see changes in the way we improve the quality of health care, we will move to the new models for clinical trials based on outcomes data.
According to Brook, by using population-based research designed to track outcomes, medical organizations will be able to monitor the history of changes in our effectiveness in treating diseases at the state and national level. It may even be used in policy determinations about how we pay for quality health care.
While Brooks vision of the future may still seem like science fiction to some, conference participants seemed eager to apply his strategies today.
Bob Brook began thinking about outcomes long before it was fashionable, and he was certainly one of the intellectual leaders responsible for making outcomes management and quality as important as they are today, Short said.
One of the measures of the quality of a keynote is the number of times that other presenters refer to the keynote address, she added. Throughout the conference, participants came back to the points from Bob Brooks presentation. His vision really resonated with the conference participants. In many ways, it was a visionary speech, but it had good thoughts and suggestions about the limitations of outcomes, as well. Brooks address put outcomes into context for the participants.
Guest speaker Patricia MacTaggert, director of the quality and performance management group of the Center for Medicaid and State Operations in the U.S. Health Care Financing Administration, presented her thoughts about patient-centered quality and the use of outcomes in state health policy. She walked participants through the process of improving outcomes based on her experience with the Medicaid system.
MacTaggert also participated in an interactive roundtable discussion at the conclusion of the conference. National industry leaders from the Hospital and Healthsystem Association of Pennsylvania, Merck-Medco and Aetna/US Healthcare joined MacTaggert in exploring the needs and uses of outcomes data. Short moderated the discussion.
Throughout the conference, we dedicated a lot of time talking about outcomes as health care organizations, providers and professors. One theme that reemerged in the roundtable was the importance of looking at outcomes from the patients perspective. Patients have to play an important role in defining what we want out of health care, Short said.
The conference was sponsored by the Department of Health Policy and Administration, College of Health and Human Development, the Center for Health Policy Research and the Penn State College of Medicine at The Milton S. Hershey Medical Center, with support from Continuing Education. Additional funding was provided by Shared Medical Systems, a provider of hospital information systems, and Novartis Pharmaceutical Corp.