Health status can be defined succinctly as, “the range of manifestation of disease in a given patient including symptoms, functional limitation, and quality of life, in which quality of life is the discrepancy between actual and desired function.” 1 Physicians spend their lives focused on the diagnosis of patient symptoms and, since clinical classification models are primarily structured for and by physicians, most models measuring variation in population health rely on reported diagnoses. Functional limitations, limitations in activities of daily living (ADLs) or instrumental activities of daily living (IADLs), are measured (either by the patient or the health professional) by a variety of tools utilizing a variety of scales. Continue reading
One reader of my latest blog on segmenting health care consumers asked me if I knew of any tools to calculate a person’s chance of developing a particular disease. That question got me thinking again about the topic of risk in health and disease. I pulled a copy of John Last’s Dictionary of Epidemiology from my office bookshelf for a proper epidemiologist’s definition of risk:
“The probability that an event will occur, e.g., that an individual will become ill or die within a stated period of time or age. Also, a nontechnical term encompassing a variety of measures of the probability of a (generally) unfavorable outcome.”1 Continue reading
The recent report describing a decline in new cases of diabetes is good news. An article about it in The New York Times does a nice job describing the lifestyle changes individuals have made to reduce their personal risk. The article is informative on several levels: Continue reading
While we often hear about the role of good nutrition in promoting health, it is not typically discussed in the context of the Triple Aim – better outcomes, lower cost and improved patient satisfaction. What are the opportunities in health care to promote good nutrition and improve healthcare outcomes? Continue reading
Maybe there is a way to measure quality so that metrics better represent outcomes that matter.
Harvard Medical School’s Center for Primary Care has been studying exemplars in primary care through a series of case studies in the past two years. Their article in Harvard Business Review describes the finding that good outcomes are related to the strength of relationship between the primary care provider and patient. This finding is strong and consistent across all primary care exemplars in their study.i Continue reading
Improving care coordination for the sickest, most vulnerable and highest cost patient segments remains an important component of population health management and achieving the goals of the Triple Aim – better outcomes, lower costs and improved patient satisfaction. Yet, even as we acknowledge the importance of care coordination and devote considerable resources to this effort, the next question is whether these resources are being diverted to the right places to make a meaningful difference in health outcomes, cost and patient satisfaction. Continue reading
Where do alerts fit in a physician’s 22.6 hour day?
When I’m travelling around the country interacting with healthcare leaders and health systems, I mostly see valiant efforts to improve outcomes through improved management of diseases. While improving disease management through guideline adherence is certainly a good thing, this is a problematic strategy given the current reality of our tools, the design of our workflow and our ability to recognize and address the multiple non-disease factors that weigh heavily on outcomes. Continue reading
The move to accountable care is ultimately about achieving better health outcomes at lower cost while creating a better experience for the patient. This is the Triple Aim. A narrow view of health focuses on health care, which is understandable in the United States, since a wide range of health-related expenditures are funneled through the medical system. The United States has long been the leader among industrialized countries in healthcare spending, while other nations have led in health outcomes, such as lower infant mortality rates, lower mortality amenable to health care and longer life expectancy. Continue reading
It’s hard to get rid of something you use but don’t like, even if it’s no longer practical. Things that are familiar have a lot of staying power. That may be why we can’t seem to shed ourselves of the suffocating layers of quality measures that have accumulated over the years.
There are over 4,600 healthcare quality measures and measure sets in the public repository set up by the National Quality Measures Clearinghouse. Granted, these measures represent all settings and aspects of care delivery and management. The numbers are still staggering: Continue reading
Reducing healthcare costs through better care delivery begs the question: “Where do we start?” When the goal includes something to the effect of “the greatest possible improvement for a population,” it is good to reflect on the body of evidence pointing to high performing population health outcomes.
The work of Starfield and others is instructive: High performing health systems have high performing primary care as their foundation. High performing primary care has four cardinal features:¹ Continue reading