WHAT WE'RE LEARNING

Dear Colleagues—

The best care as we age is always based on what matters most in our lives.

William Osler, the father of modern medicine once said “The good physician treats the disease. The great physician treats the person who has the disease.” Although physicians, nurses and other clinicians intuitively know this, the way we measure quality in health care almost always leads to a focus on the condition or injury. We gauge success by lowering cholesterol levels, adhering to a prescribed medication or controlling blood pressure when what really matters to the older adult might be feeling well enough to walk with a friend or play with a grandchild. In fact, care driven by clinical indicators alone may incentivize excessive treatments, tests and otherwise avoidable interventions.

Over the past seven years, the National Committee for Quality Assurance (NCQA), an independent, not-for-profit leader in health care quality, joined forces with individuals and families, researchers, clinicians and managed care organizations to collaboratively develop and test quality indicators called person-driven outcome measures. Most recently, these outcome measures were tested for feasibility and scalability through a demonstration project funded by The John A. Hartford Foundation and The SCAN Foundation.

Using Person-Driven Outcomes
Using Person-Driven Outcomes


Under this measurement method, patients and clinicians work together to identify goals their care should help them achieve. For example, in consultation with their clinician, an older adult who has been homebound may set a goal of going outside once in the next three months, while another may want to address side effects from a prescribed medication such as loss of appetite. Measurements of success are whether the person-driven goals were elicited and documented and whether follow-up and progress are made toward achieving the goals.

The results are in: Person-driven outcome measures are feasible, valid and preferred by clinicians over traditional quality measures. The measures also performed well among people with complex health status and their caregivers and pointed to better care outcomes, resulting in a significant reduction in hospitalizations in the demonstration project.

Participating sites reported that keeping the goals and measurements flexible helped maintain meaningful patient engagement. Rather than reinforcing a treatment plan that was not working, the interdisciplinary members of patients’ health care teams asked them to redefine clinical success and chart a new path to achieve it. This type of collaborative approach helped people remain committed to their care and improved the relationship between patients and their clinicians.

NCQA identified two methods of measuring progress toward person-driven outcomes. The first method, patient-reported outcome measures (PROMs), prioritizes and measures a single symptom or domain associated with a goal. A long-used and well-researched PROM measurement system, known as the Patient-Reported Outcomes Measurement Information System (PROMIS), can be integrated into the electronic health record to monitor peoples’ goals, whether these goals are related to physical, mental or social health. The second method, goal attainment scaling, allows the clinician and patient to jointly develop and track a unique patient goal, creating possible quantifiable outcomes for that goal.

Example of Custom Goal Attainment Scaling


The next step is bringing these measures to scale. NCQA will now work to spread awareness and use of this approach among clinicians and integrate the person-driven outcome measures into reporting structures and value-based payment arrangements. It is essential that clinicians adopting this method are well-prepared to have conversations with their patients about goal setting and know how to evaluate progress. Patient Priorities Care offers tools and training guides for health care teams on goal setting and includes a guide for clinicians to direct patients to set their own goals prior to a health care visit.

Every older adult and clinician in every setting wants greater value from their health care interactions. Person-driven outcome measures will help achieve this. Clinicians recognize the value in a process that fosters trust because it helps patients accomplish what matters to them. Federal and state policymakers and payers should also recognize the value given the potential to reduce unwanted or harmful care. With collaboration among all of these stakeholders, we can profoundly transform the way high-quality care is delivered, measured and paid for. We invite you to learn more and get involved with NCQA and our other partners as “What Matters” becomes elevated and embedded in the fabric of health care.


Sincerely,

Nancy Wexler, DBH, MPH
Program Officer, The John A. Hartford Foundation

Learn more at NCQA’s website.