Improving Patient Outcomes

In the new world of value-based care

2016-04-20

Due to increasing cost pressure, established remuneration models for healthcare services are in transition around the world. As part of the move toward value-based care, patient outcomes are coming under the spotlight. Thus, hospital managers face the challenge of improving overall patient outcome cost effectively.

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Key takeaways:

  • Promote more well-informed diagnoses: An accurate and quick diagnosis is the foundation for proper treatment decisions. Modern diagnostic exams help increase diagnostic quality, thereby reducing downstream costs resulting from misdiagnoses.
  • Support optimal treatment planning: Treatment can be efficient without being effective, and vice versa. Ensuring that treatment is both efficient and effective is the hallmark of medically and economically successful healthcare providers.
  • Take good care of your clinicians: An antagonistic work atmosphere for clinicians and nurses translates into inferior outcomes for patients. Providing a supportive workplace environment leads to happier employees, which in turn yields better patient care.
  • Improve outcomes through greater transparency: To ascertain the success of improvement measures, patient outcomes must be clearly defined, reliable, and transparently evaluated. True measures of quality should reflect what matters to the patient.
  • Ensure continuity of care following discharge: The seamless flow of information along the treatment pathway is an essential component in the overall success of the treatment. Especially when it comes to hand-offs, there is often still room for improvement.
  • Engage and support your patients after discharge: More positive patient outcomes can be achieved if patients are actively involved in the treatment process. Clear, intelligible communication is the key to success.
  • Use connected care to support better outcomes: Modern, connected IT, as well as the use of mobile devices, can contribute enormously to advances in diagnostics and treatment. This is especially true for regions of the world that are still medically underserved.

Diagnosis: Making Well-Informed Decisions
Every successful treatment and pathway to a positive patient outcome begins with a correct and timely diagnosis. Usually, when a patient goes to see a doctor, the first few minutes determine the subsequent treatment steps – which directly influence the success of the treatment, and its cost. However, diagnosis itself can be a particularly complex challenge. Research suggests that, in the U.S. for example, diagnostic errors affect one in 20 patients annually, and an estimated 12 million Americans each year.1 Moreover, diagnostic error is the leading cause of medical malpractice claims in the U.S. (almost 30 percent), and is estimated to cause 40,000 to 80,000 deaths annually.1


As demanding as it is to identify and avoid diagnostic errors, it is well worth the effort, as doing so significantly improves patient outcome. Misdiagnosis can lead to unnecessary treatment for non-existing conditions, or to proper treatments initiated too late or not all. This not only impacts the patient, but providers as well. Providers are increasingly facing the operational and economic consequences of incorrect medical care – for instance, when lengths of stays are unnecessarily long, medications are used incorrectly, or avoidable exams and operations are performed. The results are often a worsening of the patient’s condition, readmissions, reduced efficiency, and, in the worst case, expensive legal battles.

Efficient and Effective Treatment
Usually, the diagnostic procedure is followed by a treatment decision. In the interests of patient outcome, diagnosis and treatment should be considered as two separate decision-making processes to be optimized, because the initial diagnosis could be incorrect or incomplete. In addition, even if the diagnosis is correct, there are often several possible therapeutic approaches. For good treatment decisions, it is important to know all the options. These arise from one’s knowledge of the individual medical condition, the patients themselves, and scientific findings. Electronic health records (EHR) and a seamless flow of information between physicians and specialists, and science and technology, can play a crucial role here.


The variety of treatment options and the uncertainty of planning them are the areas in which patient outcomes and sensible resource allocation are at risk. Treatment should be efficient as well as effective, and should lead to the desired outcome. Clinical monitoring will become more important for optimizing patient outcome and maximizing cost efficiencies. Up-to-date diagnostic imaging and laboratory equipment can support the ongoing, near-time monitoring of treatment success. However, many hospitals delay modernization of expensive devices due to increasing cost pressure. This can create significant national differences in hospital equipment between richer and poorer countries. For example, data on European equipment stocks show that patients in Eastern Europe in particular have very unequal access to MRIs and CTs.2

Improved Outcomes through Quantification
The quality of diagnosis, treatment decisions, and monitoring/management of the treatment significantly determine patient outcome. According to U.S. economist Michael Porter, provider organizations - facing lower payment rates and potential loss of market share - have no choice but to improve value and be able to prove it. Although hospital managers have now recognized the need, in practice they often still lack suitable measurement methods. Most quality metrics do not gauge quality; rather, they are process measures that record compliance with practice guidelines. The only true measures of quality are the outcomes that matter to patients, says Porter.3

 

To gain meaningful benchmarks, care providers should actively engage patients in the collection of outcome data. Patient-Reported Outcome Measures (PROMS) are already being successfully used by various hospitals in the U.K. to improve patient outcome. For example, PROMS are used to calculate health gains after several forms of surgical treatment, using preoperative and postoperative patient surveys. Some British studies show how hospitals have successfully used PROMS data as a benchmark for their own quality measures. These best-case studies lead to the conclusion that standardization can greatly help improve patient outcome. At the same time, the case studies suggest that improved patient outcome does not necessarily have to be accompanied by higher costs, and can actually improve profitability.4

Creating a Continuum of Care
Especially in western industrialized nations, the present-day healthcare organization is a highly sophisticated but fragmented collection of service providers. Previously, the following of a patient’s case often ended at the point of transfer to another provider/specialist, or at discharge. Follow-up on the success of treatment rarely took place. In view of rising costs, however, providers in many countries are increasingly seeking to make optimum use of available healthcare resources. To ensure more cost-effective healthcare, providers are examining the entire care continuum to identify areas for improvement. By examining the overall patient journey, providers can potentially improve patient outcomes while reducing costs. Also, provider cooperations and alliances that encompass hospitals, physician groups, outpatient clinics, and other provider facilities are on the rise.

 

The Affordable Care Act launched in the U.S. in 2010 under President Barack Obama provides clear examples of how service providers are encouraged through financial incentives to continue making a positive contribution to patient outcome beyond the day of discharge. For instance, Medicare reduces provider compensation if patients are readmitted within 30 days of discharge. This affects every fifth Medicare patient - a staggering number of those treated. According to the Center for Medicare and Medicaid Services (CMS), approximately 2,700 of the 3,400 Medicare contract hospitals will have cuts totaling $420 million in fiscal 2016 due to such readmissions.5

Engaged Patients Improve Outcomes
For healthcare providers, it is worthwhile to examine how care is provided along the treatment chain and to optimize it as needed. In particular, the general practitioners who care for patients after their discharge, and also the patients themselves, have a considerable influence on patient outcome. Survey and research results from the U.S. show that handoff communication and the discharge process are sorely in need of improvement in many companies. For instance, in the latest annual U.S. national patient survey, 14 percent of respondents said they had neither received any written information about what symptoms or health warning signs they should look for in the future, nor had conversations about the need for a follow-up appointment and with whom after their discharge.6


However, the patient’s proven influence on his or her own outcome may be challenging in cases where service providers find it difficult to increase patient engagement. Socioeconomic factors such as low income, unemployment, and poor education can lead people to neglect their health and fail to follow their doctors’ recommendations or keep appointments. Several studies from the U.S. actually show a link between high readmission rates and a hospital’s catchment area. It indicates that hospitals in poor regions are disproportionately affected by readmission penalties.7 This once again shows how important it is to develop reliable and reasonable outcome measurements.

Smarter Data for Better Care
A well-managed IT infrastructure and mobile technology could help to smooth the patient pathway and encourage patient engagement, for example by helping patients and doctors stay connected via mobile resources like tablets and smartphone apps. Thus, visit-based care is giving way to connected care. In developed economies, some of the greatest benefits of connected care would result from improved treatment of chronic disease. Furthermore, the greatest benefits of Internet-of-Things applications could lie in expanding delivery of healthcare services to the underserved, write the corporate consultants at McKinsey in a recent study.8


The EHR that have been introduced in many countries also provide a shared platform for decision-making between patients and doctors. According to a recent survey by the consulting firm Accenture, more than half of all patients want to be able to access their data online.9 This would definitely be to the benefit of many doctors. A vast majority of U.S. doctors report that patient updating of personal electronic medical records improves patient engagement and satisfaction.10 Healthcare providers who manage to create stronger ties to their patients and let them independently contribute to their patient journey can achieve better long-term patient outcomes.


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Related Articles

1Society to Improve Diagnosis in Medicine, www.improvediagnosis.org

2COCIR, Medical Imaging Equipment, Age Profile & Density 2014

3Harvard Business Review, The strategy that will fix health care, Michael Porter and Thomas H. Lee, 2013

4Health and Social Care Information Centre HSCIC, PROMs Benefits case study, 2015

5Modern Healthcare: Medicare readmission penalties create quality metrics stress, http://www.modernhealthcare.com/article/20150808/MAGAZINE/308089963

6HCAHPS online: http://www.hcahpsonline.org

7JAMA Internal Medicine, Patient Characteristics and Differences in Hospital Readmission Rates, 2015

8McKinsey Global Institute, The Internet of Things: Mapping the value beyond the Hype, 2015

9Accenture Healthcare IT Vision 2015, top 5 eHealth Trends

10Accenture doctors survey 2015

11Joint Commission Center for Transforming Healthcare, www.centerfortransforminghealthcare.org

The statements by Siemens’ customers described herein are based on results that were achieved in the customer's unique setting. Since there is no "typical" hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results.