Outcomes, shmoutcomes: What can the patient do?

Company asks home care to redefine data measures

Everyone is talking about the importance of outcomes measurement in virtually every branch of medicine and its allied fields. But according to one company, defining outcomes is key, and looking at vague measurements that don't have real value to patients won't hold water in the future.

Ernie Bryant, PhD, AACN, is director of clinical services at Paradigm Health Corporation, a Concord, CA, company that specializes in catastrophic injury management. His company assumes all the risk for a patient, guaranteeing payers it will bring those patients to a specific level of functionality within a specified time for a specific cost. That, he says, is the future.

Bryant knows home care companies are being forced to think about outcomes through various initiatives, both private and public. But he says what they see as outcomes measurement doesn't address the functional goals Paradigm sets.

"In my experience, home care companies spend a lot of time looking at length of treatment. It's an issue of benefit utilization and expenditure. What we want is information on functional change."

Home care companies that can provide this type of outcomes data will have a unique position in the future market. "There will be plenty of work to be had by home care companies that can point to specific functional outcomes."

Bryant sees another problem: Home care staff concentrate on incremental changes, such as an increased range of motion in a patient's shoulder of five degrees. "That doesn't mean anything, though," he says. "A patient being improved enough to put on his own socks, or being able to do his own wound care - that means something."

While Paradigm is now the only U.S. business doing at-risk, outcomes-oriented catastrophic injury management, he's sure there will be followers. That means home care organizations will have the chance to bid for this kind of business. Right now, Paradigm has some global contracts with large providers, but depending on the case, payer, and area, there are opportunities for others.

What does that mean to home care? Bryant says it means agencies need to look at functionality as an outcomes measure. Contracting agencies don't collect any of the data for Paradigm, he says. That is done by case managers who often attend visits and evaluate performance with the assistance of the physician in charge of the case, the patient, and his or her family.

The right data can sell your services

However, agencies might want to collect these data themselves because they offer a marketing opportunity. For instance, Bryant says he would be impressed if an organization could say how many visits it would take to teach a family enough about wound care to provide the care without any resulting infections, or to teach a family catheterization skills. If an organization could do that and take the financial risk by guaranteeing that functional outcome, Bryant says he would be interested in working with them - and in paying a premium price for the guarantee.

Teaching skills is one of the most important areas of functional outcomes for Paradigm, says Bryant, but others also weigh heavily. For example, toilet transfer capabilities are a big issue. If an agency guaranteed it could, in four weeks, improve endurance and strength so a patient goes from transferring with a moderate level of assistance to a supervised self-transfer, that would be meaningful to Paradigm. "It has to be on a functional level," he says. "Saying something will improve over time isn't enough. But going from moderate assistance to supervision is meaningful."

There will be more and more companies doing this kind of work, says Bryant, and in more areas. Paradigm is starting a program for premature infants this summer, and in the future it may develop a program for organ transplant patients.

"Outcomes alone aren't a function," he says. "You have to make sure that the outcomes you measure have an impact on the lives of the people you care for. We want to see functional differences that are objectively measurable in a numerical fashion."