S224 - Day 1 - 1200 - Outcome measures in person centred co-ordinated care, what are we measuring
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Transcript of S224 - Day 1 - 1200 - Outcome measures in person centred co-ordinated care, what are we measuring
Outcome measures in person-centred careWhat are we measuring and why?
Dr Alf CollinsClinical Associate in Person-Centred Care
The Health Foundation
Dorothy
Dorothy is 79 and was recently widowed- she now lives alone and life is a struggle. Her knees are playing up- she is seeing a surgeon next month to discuss an operation. She is worried about that- her diabetes hasn't been good for a year or two and her doctor has recently told her that her smokers cough is more serious and is something called 'COPD'. All in all, she is feeling quite low; maybe she should talk to someone? Maybe she should even think about moving home- even the stairs are a struggle now.
1. How do we make sure thatthe system puts Dorothy first? In everything it does? Always?
2. What is the system trying to achieve?
If the system is (primarily) trying to:
• Manage HbA1c in its population of diabetics• Reduce unscheduled hospital admissions• Reduce length of stay for people with LTCs
It won’t necessarily put Dorothy first
Our system. The House of Care
Engaged,
informed patients
HC
Ps com
mitted to
partnership working
Organisationalprocesses
Responsive commissioning
Accurate contact details
IT: clinical record of care planning
Know your population
Test results and agenda setting
Consultation skills and attitudes
Integrated, multi-disciplinary team
and expertise
Senior buy-in and local champions
Prepared for consultation
Information and structured education
Emotional and psychological
support
Develop market to meet current and future needs
Identify needs, map resources
Quality assure and monitor
Establish and publicise menu of care
Ensure time for consultations, training and IT
Collaborative care and support planning
Successful systemsPrinciples, activities and purpose
• Focus on purpose (the outcome they are trying to achieve)
• Put in place processes (activities) to deliver on outcome
• Underlying the processes are principles; propositions that serve as foundations for a chain of reasoning
Successful systems
Principles Processes Purpose
Successful measurement systems
PrinciplesProcess
MeasuresOutcomeMeasures
Successful measurement systems:
• Focus on purpose (‘why measure?’)– Insight– Improvement– Assessment– Judgment
• Are parsimonious (fewest possible number of indicators- especially outcome indicators)
• Are coherent (indicators logically relate to each other)
High quality systems demonstrate process reliability
Outcome
Process 1
Process 2
Process 3
Measurement coherence
Outcomemeasure
Process measure 1
Process measure 2
Process measure 3
What are the principles of person-centred care?
Dorothy should always be treated with dignity, respect and compassion
Dignity, respect, compassion
She should also experience co-ordinated treatment, care or support
Dignity, respect, compassion
Co-ordination
She should also experience personalised treatment, care or support
Dignity, respect, compassion
Co-ordination
Personalisation
She should also experience enabling treatment, care or support
Dignity, respect, compassion
Co-ordination
Personalisation Enablement
Principles• Compassionate• Co-ordinated• Personalised• Enabling
Collaborative care and support planning
Outcome
What is our outcome?
Care plans and care planning
Care plans- outputs not outcomes
A primary assumption:Self management is usual care
Hours with NHS / social care professional = 3 in a year
Self management = 8757 in a year
The system should support Dorothy to develop the knowledge, skills and confidence to manage her own health
Measures of knowledge, skills and confidence to manage own health
• Unidimensional– Patient Activation Measure (PAM). 13 items
• Multidimensional– Health Literacy Survey for Europe Questionnaire
(HLS-EU-Q). 47 items. – Health Literacy Questionnaire (HLQ). 44 items– Health Education Impact Questionnaire (heiQ). 42
items
All are stable and reliable with high construct and face validity
Questions: Practical utility and predictive power
Patient activation measure: useful and predictive
• Unidimensional (ie measures a single concept)• Developmental (ie appropriate interventions
can support people to progress on a journey of activation)
• Knowledge, skills and confidence to self manage• 13 items• Score out of 100• 4 levels
7% of population
14% of population
21% of the population has low or no confidence to self manage
People at low levels of activation tend to:
• Feel overwhelmed with the task of managing their health
• Have low confidence in their ability to have a positive impact on their health
• Not understand their role in the care process• Have limited problem solving skills• Have had a great deal of experience with failure in
trying to manage, and have become passive with regard to their health
• Say they would rather not think about their health
As compared to people at low levels of activation, people at higher levels tend to:
• ‘Be engaged’– Come prepared– Ask questions– Make decisions– Have less unmet needs (nb inequalities)
• Have improved clinical outcomes (including mental health)
• Enjoy an improved quality of life • Use less healthcare resource• Feel satisfied at workWhy Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes. Jessica Greene and Judith H. Hibbard Journal of General Internal Medicine, published online Nov. 30, 2011
People with Lower Activation Associated with Higher Costs; Delivery Systems Should Know Their Patients’
‘Scores’
Tailored interventions can support people on their journey of activation
Thus tailored interventions improve all other ‘downstream’ indicators
Uses of patient activation measure
Segmentation• Target resources• Use resources
more effectively
Tailored coaching• Start where
people are• Personalise
support
Programme assessment• Quality assure
interventions• Improve quality of
interventions
Predictive modelling• More
sophisticated understanding of drivers of risk
Integration: a means to an end
integration Co-ordination Activation
The enabling process of scheduled collaborative care and support planning
PREPARATION
Professional Agenda
Personal Agenda
Follow upPersonal GoalsNegotiated agenda
Output= care planOutcome= activation
Downside is licencing
NHSE in active negotiation with licence holders (Insignia)
NHSE PAM learning setContact me:
Launch of Kings Fund Monograph (Helen Gilburt and Judith Hibbard)May 6th 2014