Patient-Reported Outcomes: “We Need to Look into the Details”
July 15, 2013 | Dr. Jens Deerberg-Wittram is convinced that healthcare systems can raise their value by constantly measuring clinical outcomes that matter to patients. As president of the International Consortium for Outcome Measurements, he is pushing his conviction in the healthcare world.
How is the measurement of data working?
Deerberg-Wittram: I think the first step is what is really important. I’ll give you an example. Maybe you’re treating patients with breast cancer. So, if you ask them “What matters to you?” there will definitely be a number of things. One might be the issue of anxiety. If you consider this important, then you have to define how to measure and when to measure it. It makes a big difference whether you measure it at the beginning of treatment, during treatment, or months or even years after treatment. And there are different instruments for measuring anxiety. The good ones are validated, standardized instruments that are used by psychologists and psychiatrists. So, why don’t we use these? It might also be important to decide whether these instruments are used by professionals or by the patients themselves. We call the latter “patient reported outcomes”.
So, defining how to measure, who is measuring, and when we should measure outcomes – these are the most important things. And we believe this needs to be standardized in order to compare results from across the globe.
What is the effect of the data collected?
Deerberg-Wittram: There are three main effects if we collect outcome data regularly. The first one is: As a patient, you can make informed choices. So, if you know that the outcomes at a certain hospital are particularly great, you might prefer to go there than to other places. The second effect is for the physicians and the care teams. If they get feedback regularly on how good they are doing or where there are areas for improvement, they will improve. Healthcare professionals always want to do the best for their patients. So they will use these data. And there is a third effect for health plans that have the ability to shape contracts around quality rather than volume and numbers of procedures.
How exactly do hospitals collect their data?
Deerberg-Wittram: There are different ways to collect data. In some areas, we still use the good old pen and paper model. And to be very honest, sometimes this is still sufficient. Most hospitals today have so-called electronic medical records where they use systematic software solutions to collect all the data necessary through the whole care process. The newest approaches are those where you really ask the patients themselves to provide data using mobile phone technology or tablets. In this case, the patient collects the data maybe a thousand miles away from the hospital and independent of meeting with a physician.
In terms of financial aspects, how does data impact?
Deerberg-Wittram: The impact is huge. We see that there are still a lot of healthcare systems appyling the so-called “fee for service” model which basically says: ‘The more procedures you apply, the more you get. The more expensive procedures you apply, the more money you get as well.’ So we have a tendency in many countries – particulary in the USA – to do more procedures than we need to and to do more invasive procedures than we should. If we want to move to a more value-based system where we are basically doing the right number of procedures and the right degree of complex procedures, then we have to shift reimbursement models. And what we see in the USA – and also in some European countries like in Sweden – is that there is now a shift towards more value-based reimbursement and that organizations are paid for taking care of a number of patients over time instead. It is their responsibilty to decide when to do surgery, when to give a patient medication, and how to treat them. We believe that this is the right thing to do
What does value mean to you?
Deerberg-Wittram: Value in healthcare is defined by a very simple equation: Value is medical outcomes achieved per dollar spent. This is basically a very simple concept that is applied in any other industry around the world. Now, when you are buying a car for example, you always ask yourself what the particular value of the product is for me. This might be very different from one person to another and might result in different choices. So, in our daily life, we very often make these decisions: What is the particular benefit I expect from a product? How much money am I willing to give?
In healthcare, we don’t apply that principle. This is a major flaw in the system. The first question in healthcare is always: What is the benefit for the patient? And the benefit for the patient is defined by the outcomes you can achieve by solving the problem of a certain medical condition. As a patient, there are a lot of things you want to know. And of course you want to know if the hospital around the corner is better than the other one down the street. This kind of information is very often not accessible in a structured way, and it’s really hard to make the decision on where to go to.
The second part of the equation is the money. The money is typically paid by health insurance companies, so very often patients don’t even know how much a certain procedure costs. To be honest, mostly they don’t even care. But of course, at the end of the day you are also paying the price for the procedure.
So, we believe value-based healthcare means making all these data available and then making the decision based on value rather than on prices alone or outcomes alone or – what is even worse – making the decision without any information.
What is your personal motivation for working on outcome measurements every day?
Deerberg-Wittram: In my previous role I was working as a hospital executive. I have learned over the years that there are great people who are really motivated to do their best for their patients. So, it’s our obligation to provide these colleagues with data on how to improve, how to learn from each other. I think this is a great thing. I’m a physician myself, so I believe I can contribute this to my dear colleagues. That would be a great and fantastic step. This motivates me – and to be honest, over years, I have seen so many examples in my past organizations of how people have improved in their work. I had the feeling that we had to bring that to a higher level. And ICHOM is the sounding board for that.