Four Key Recommendations for Collecting Patient Outcomes

Healthcare providers that want to transition to Value-Based Health Care need to measure patient outcomes. Delivering value to patients is about improving outcomes and decreasing costs (Porter, 2010). Measuring outcomes is the first step in understanding the performance of a healthcare provider and identifying what needs to improve. Once a healthcare provider has implemented its improvement strategy, it can use outcomes measurement to assess whether the improvement efforts have been successful.

Patient outcomes reflect the state of health of an individual and measure the results of healthcare delivery (Porter, 2010). A healthcare provider can be successful only if it can achieve good patient outcomes. Outcomes measurement is complex and it involves the assessment of different aspects of the health of a patient using tools such as PROM questionnaires, clinical measures and quality of life assessments.

Often times hospitals focus only on length of stay, re-admission rates and mortality but do not measure all the other outcomes. It is advisable to consider the following recommendations if you decide to take a further step and broaden your outcomes measurement to include all the outcomes that are relevant to your patients:

1. Integrate outcomes collection in your healthcare processes

Healthcare providers need to ensure that they understand how they deliver care to patients. Process mapping can be one of the tools to consider to achieve this goal. A process map is useful to illustrate the journey of the patient and the steps of the healthcare processes.

Providers that understand how they deliver care to patients can decide when to collect outcomes. Another key decision is to identify the person who has to collect the data. In some cases, it can be the receptionist, the patient himself or herself or even the clinician. The choice of the person collecting the data depends on different factors. For example, a clinician collecting data on the level of pain can generate a bias in the results if patients are reluctant to freely express themselves in front of the clinician.

Providers should try to make outcomes collection efficient. Idle times in the healthcare journey can be an opportunity to consider. For example, a patient, who is waiting in the reception, can fill out a questionnaire without causing any extra delays to the delivery of care.

2. Focus on the organisational culture

There are different definitions of organisational culture, one of the most practical is ‘how we do things around here?' (Vincent, 2010). Clearly, changing organisational culture is complex, especially, when members of an organisation do not believe that a change will bring any benefits.

Clinical champions can support the change efforts. It is likely there will be resistance when providers decide to start to collect a variety of patient outcomes. It can be helpful to identify clinicians who are well-respected and authoritative in the ward where there is the goal to start collecting the outcomes. These clinicians can become the champions of the project and engage the rest of the ward on the usefulness of the initiative.

Outcome collection is complex and failures can be extremely detrimental. It can be helpful to focus on low-hanging fruit when you start to collect outcomes. For example, collecting outcomes for medical conditions inwards where physicians have shown to have an interest in Value-Based Health Care. Another factor to consider is to choose a medical condition for which data is easy to collect. Data can be easy to collect when the amount of information to gather is limited and for patients whose healthcare journey has a limited and predictable number of stages. 

It is key that healthcare providers use outcomes data to improve processes and not blame their staff. Real outcomes improvement exist only when collecting data has the goal to improve performance. Using data to create a blame culture can be a fatal error. Transparent discussions on how to improve are essential for operational improvement and they can occur only if the healthcare professionals do not feel threatened by the use of data.

3. Keep improving your data collection

It can be complex to collect data. It may be reasonable to start with a limited number of patients and then extend the data collection to a wider population. Identifying issues with a small group decreases their potential impact and makes it easier to test potential remedies.

An audit of the data is needed to assess their quality. Healthcare providers need to understand the amount of missing data and potential incongruities in the data collection. It is key to ensure the data are correct and there are no inconsistencies.

It is useful to perform audits regularly and to use this information to improve the data collection. It is necessary to understand where there are issues that cause missing data, errors in the data collection and integrity problems. Improving data collection is a continuous effort to ensure the data available keeps improving.

4. Invest in technology

Manual collection is an option to start collecting outcomes data but it can have some drawbacks. For example, it can be expensive when it requires transcription of the data into electronic devices. There can be errors due to transcription that may be difficult to avoid. When the provider collects data using postal questionnaires, some patients will not send their data back if they find the process to be too burdensome or if they forget about it.

Identifying the electronic hardware to collect the data is essential. Tablets provided on-site are typically an effective tool and the hospital staff can support the patients in case they have any questions or encounter any issues. Some hospitals send a link to patients to fill out online surveys. Questionnaires that patients fill out at home may have lower response rates if, for example, a patient does not access their email regularly and misses the email from the healthcare provider.

IT provider selection for the software to use is essential. Factors such as compatibility with the current information systems, scalability and cost are all relevant dimensions to consider. Another essential aspect is usability for the patient and for the hospital staff. The software to collect patient outcomes needs to be easy to use and intuitive. Analytics, reporting and AI capabilities can have a relevant role in the goal of outcomes improvement.

References:
Porter, M.E., 2010. What is value in health care? N Engl J Med, 363(26).
Vincent, C., 2010. Patient safety. 2nd edn. John Wiley & Sons.