Outcomes summit finds much work to be done

By Joan Lawson, CMSC

Sacramento, CA

Ten years ago, the American Group Practice Association (now known as the American Medical Group Association) accepted Paul Ellwood's, MD, challenge to add quality of care to its mission and develop measurements designed to improve efforts in patient care. Last month in Jackson Hole, WY, the group's Outcomes Management Consortia (AMGA-OMC) gathered to celebrate that event, review their progress, and focus on the future of medical outcomes. Here are some highlights from the summit.

Ellwood delivered the keynote address and stated, "It is time to educate the patient about quality, personal responsibility, and the downside of asking for too much [health care] for too little cost." Ellen Severoni, co-founder and president of California Health Decisions (CHD), a nonprofit health care consumers group, agreed with Ellwood's assessment and said, "Health care should be a consumer-driven process of research, solutions, change, and evaluation."

John Ware, PhD, developer of the SF-36 and related quality-of-life instruments, said, "You can't manage it if you can't measure it." He called for a gold standard for measurement scales in outcomes management. "We need to put our marks in the same place." He encouraged the use of value scales permanently set within a mean of 50 and a standard variation of 10. The result would be better reproducibility and interpretation for now and into the future, he added.

Clement McDonald, MD, addressed the need for computer-stored medical records and acknowledged that, "ICD and CPT codes have gotten health care on-line, but important details [involved in patient care and which affect outcomes] are still missing. Numerous mechanisms are currently used to create electronic medical records, but systems integration remains a challenge." McDonald forecasted that a number of new technologies will effect the development of electronic medical records, including voice and handwriting understanding, radio-linked devices, wearable computers, recognition devices (such as face, retinal, and thumbprint) and Web technology.

"Patients are naïve, purchasers are penny pinchers, and doctors are more frustrated than ever," added Rodney Dueck, MD. "There are reasons to feel discouraged [about outcomes management] but also reasons to feel hope." Dueck offered an example: Physician leadership at Park Nicollet Clinic in Minneapolis decided to decrease the time from initial breast mass finding to diagnosis. The result was a reduction from 21 days to 3 hours from the beginning of the process to final diagnosis. He prompted physicians to assume leadership roles, "We [outcomes proponents] need leadership support in order to make a difference."

"More diabetic education and more glucose monitoring does not equal better diabetic care. We're doing a lot of quality of care, but it's a moving target until we can get more evidence that it works," was the challenge presented by Sheldon Greenfield, MD. He stated that clinical science needs to be integrated with costs relative to effectiveness. "There are differences between plans. We need concrete data and effective leadership [for outcomes management to succeed]," he said.

John Curd, MD, vice president of clinical development at Genentech Inc., offered a glimpse at the future of outcomes management through genomic technology. He explained that genomics, in the very near future, will render 5,000 to 10,000 pieces of information about a patient in a single blood sample. As an example, Curd described a very sick patient and a single blood sample that indicated the patient's genetic disposition, diagnosis, specific response to medications, and optimal treatment for the condition. Curd concluded that this was the optimum in outcomes prediction.

Alfredo Czerwinski, MD, led the summary panel discussion and closed the summit with the following metaphor, "Today, the newest Boeing 737 and the 777 aircraft have nearly identical instrument panels, and all the pilots who fly them follow standard procedures. Commercial passengers have a remarkably safe experience with highly predictable outcomes." Referring to clinical outcomes management efforts, Czerwinski concluded that, "Our work in physician-driven outcomes measurement and management, though still evolving, gives rise to optimism that health care providers will be able to fulfill, and possibly exceed, patient-consumer expectations."

[Joan Lawson is the founder of Lawson & Associates, a network of health care consultants with special expertise in outcomes management, practice management, credentialing systems, managed care, informatics, and leadership development.] n

Medical Group Management Association 72nd Annual Conference - Oct. 4-7, Denver. Sponsored by MGMA, 104 Inverness Terrace East, Englewood, CO 80112-5306. Telephone: (303) 799-1111. Fax: (303) 643-4427. World Wide Web: http://www.mgma.com.

Peer Review System's Fourth Annual Quality Summit - Effective and Innovative Uses of Quality Information - Oct. 16, Columbus. Contact: Matt Schutte, Public Relations Manager, Peer Review Systems, 757 Brooksedge Plaza Dr., Westerville, OH 43081. Telephone: (614) 895-9900, ext. 106. Fax: (614) 895-6784.

Survival Strategies Through Innovation and Partnership - Oct. 29-30, Houston. Sponsored by St. Luke's Episcopal Health System. Contact: Betty Walding at the Center for Clinical and Quality Integration, 6720 Bertner Ave., MC4-278, Houston, TX 77030. Telephone: (713) 794-6190. Fax: (713) 794-6717. E-mail: bwalding@sleh.com.

Hysterectomy Change Symposium - Oct. 29-30, Tampa, FL. Sponsored by the Institute for Healthcare Improvement, 135 Francis Street, Boston, MA 02215. Telephone: (617) 754-4800. Fax: (617) 754-4848.

Medical Outcomes Trust State of the Art Health Outcomes Conference - Nov. 2, Boston. Sponsored by the Medical Outcomes Trust, 8 Park Plaza, Suite 503, Boston, MA 02116. Telephone: (617) 426-4046. Fax: (617) 426-4131. World Wide Web: http://www.outcomes trust.org.

HCFA Health of Seniors Conference - Nov. 3, Boston. Sponsored by HCFA and Health Services Advisory Group, 301 East Bethany Home Rd., Suite B157, Phoenix, AZ 85012. Telephone: (602) 665-6131. E-mail: azpro.mjack son@sdps.org. n

Agency for Health Care Policy and Research, Rockville, MD. Charles Darby, CAHPS Project Officer. Telephone: (301) 594-1349, ext. 1316.

Dean Medical Center, Madison, WI. Sheryl Thies, Vice President, Marketing. Telephone: (608) 250-1096.

Foundation for Accountability, Portland, OR. Christina Bethell, Director of Accountability Measurement. Telephone: (503) 223-2228.

Health Assessment Lab, Boston. John E. Ware Jr., Director. Telephone: (617) 636-8098.

Lakeview Medical Center, Suffolk, VA. Stephen E. Zimberg, Vice President. Telephone: (757) 934-9329.

RAND, Santa Monica, CA. Ron Hays, Senior Scientist. Telephone: (310) 794-7508.

Tucson Orthopaedic Institute, Tucson, AZ. Chris Arslanian, Director of Research. Telephone: (520) 324-3900.

Williamson Institute for Health Studies, Virginia Commonwealth University, Richmond, VA. Louis F. Rossiter, Professor, Health Economics. Telephone: (804) 828-5223. E-mail: rossiter@hsc.vcu.edu. n