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Why Focus on Health Outcomes?

a change in direction

a forty one billion dollar question

Inputs - resources needed to carry out a process or provide a service

Outputs – the direct result of the interaction of inputs and processes in the system; the types and quantities of goods and services produced by a service.

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The Measurement of Output and Productivity in the Health Care Sector in Canada: An Overview (Sharpe, Bradley and Messinger)

Conclusions:Price indices for health care output may be overestimatedBetter documentation of methodologies Quality improvements are not capturedNot clear whether increased spending on health is due to higher prices or increasing quality and quantity

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What are Health Outcomes?

A measure of the effectiveness of our health care system and of the impact of public policies that influence health

The effect on health status from performance (or non-performance) of one or more processes or activities carried out by healthcare providers. USAID health and workforce improvement project

Health outcomes are used to examine the rate of death or illness (eg, the number of lung cancer deaths per 100,000 people).North Dakota health indicator glossary

A health outcome is: A change in the health of an individual, or a group of people or a population that is wholly or partially attributable to a health intervention or a series of interventions.Australian government website

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Choose outcomes that count

WHO estimates 1/3 of all social and economic costs to society are due to chronic diseases caused by tobacco, alcohol, high BP, high Cholesterol ad obesity30% of Canadian have at least one of seven high impact chronic health conditions and 1/3 of these people have multiple chronic health conditions

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Health Outcomes – the players

Public Policy Makers

Health Care System Managers

Health Care Providers

Individuals, families and communities

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Why Focus on Diabetes or Obesity?

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How do we provide care now?

Canadians with diabetes:

< 50% get all the recommended tests and procedures that experts recommend

> 50% have poor cardiovascular health

~ 50% do not achieve recommended levels of blood sugar

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We know the problem

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Collaborative care makes a difference

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Effective health records

Australia Canada Germany Netherlands NZ UK US

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Quality Care makes a difference

*Quality – receives recommended tests and Rx over 5 yrs

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How can we do it better?

Move from find it, fix it to prevent it, find it, manage it

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Approaches to improving quality of care include effectively measuring outcomes

Teams: Interprofessional teams and case management improve quality of care

Technology: Electronic health records, reminder and clinical-support information systems can improve quality of care and outcomes

Tools: Training and support to set and monitor goals improves quality of care

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Conclusions

Health care (not medical care) requires inter-sectoral cooperation as much as inter-provincial cooperationHealth care is a major contributor to the health of the economy and healthy communities are more viableHealth care with good outcomes is a contributor to society not a cost

We must have appropriate information systems to support health outcome assessment (Visa)Concentrate on a few outcomes with the greatest impactWe need specific assessment of individuals within communities over time

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Thank You

www.healthcouncilcanada.ca

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OECD Health Status Ranking

Health Status

United States

US Rank in OECD

Canada Top Ranked

Infant mortality

6.8/1000 live births

26 5.3/1000 live births

Iceland

2.7/1000

Maternal mortality

9.9/105 births

22 4.4/105

births

Switzerland

1.4/ 105

Life expectancy from 65 yrs

19.8 yr

16.8 yr

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9

20.6 yr

17.1 yr

Japan (23)

Iceland (18)

Adapted from We Can do Better – Improving the Health of the American People. Steven A Shroeder.Shattuck Lecture, N Engl J Med 357;12 September 20, 2007

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Number of US Deaths from Behavioral Causes, 2000 (Mokdad et al)

0

50

100

150

200

250

300

350

400

450

SexualBehavior

Alchohol MotorVehicle

Guns Drugs Obesity Smoking

Deaths/1000

We Can do Better – Improving the Health of the American People. Steven A Shroeder.

Shattuck Lecture, N Engl J Med 357;12 September 20, 2007

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Health Outcomes – Health Council of Canada

The Players Outcomes that can be affected:

Public Policy Makers Build healthy public policy

Create supportive and healthy environments

Health Care System Managers Reorient health care services to support health and prevent disease

Strengthen communities to promote health

Health Care Providers Access to needed care

Care that is coordinated, integrated and comprehensive

Individuals, families and communities

The public is engaged in their health care and patients are empowered

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Change the way we organize and deliver health care for people with chronic conditions

Provide better care for high-risk populations

Coordinate sustained action on prevention