No excuses! You can beat the barriers to outcomes
No excuses! You can beat the barriers to outcomes
Expert advice on time, money, patient concerns
Why do so many people talk about outcomes management but so few do it? Perhaps it is the clash between the ideal of monitoring and improving patient care and the reality of pressures facing busy practices. In many cases, practice administrators or physicians simply don’t know how to start.
Collecting and analyzing outcomes data can be a daunting task. The obstacles to outcomes management can seem overwhelming. After all, most practices aren’t set up to track trends or conduct what is essentially clinical research. Physicians and staff are already stressed with productivity demands and a waiting room full of patients.
But those barriers aren’t insurmountable. You can discover tools to improve patient care without disrupting your practice. Here are some of the common concerns, along with advice from experts on how to resolve them:
r It takes too much time.
Yes, it will take staff or physicians time to collect and analyze patient data. But that could be as little as a few minutes or as much as hours a day, depending on how you incorporate outcomes management into your process and how you use technology to help you.
In fact, outcomes management can save time, particularly if the physician learns about a patient’s deteriorating mental or physical functioning or drug interactions even before the patient raises the issue.
"[Using the SF-36 health status questionnaire] has improved communication with patients," says Michelle Chapman, PharmD, coordinator of outcomes monitoring program for the Nashville, TN-based DCI dialysis clinics. "With some patients, it’s difficult to bring up issues such as depression. It gives us a tool to say, You seem to be having trouble in this area.’"
Using scanners or touch-screen computer kiosks can virtually eliminate data entry. An electronic medical record allows physicians to analyze their prescribing patterns, complication rates, length of hospitalization, or other issues without additional surveys or paperwork.
Administering outcomes questionnaires, such as the SF-36, can be integrated into the work flow of the office. Jack Davis, RN, ONC, nurse clinician for New York City-based orthopedic surgeon Richard Laskin, MD, integrates questions on pain, activity level, work capacity, and other issues into his history-taking. The practice also mails patients the SF-36 preoperatively and for follow-ups, so they don’t have to spend time on it during their office visit.
"We incorporate it into the way we deliver care, so it’s automatic now," says Davis.
Implementing outcomes management will require some training of staff and physicians. In fact, the most important link will be physicians and physician-leaders, who as a group should review quality data monthly or quarterly and should champion the use of quality improvement, says Marcia Stevic, RN, PhD, director, health outcomes, for the Health Services Advisory Group, a consulting firm based in Phoenix.
"The real time and cost in terms of personnel comes from the physicians themselves learning how to interpret the data and format the kinds of reports that make sense to them," says Stevic, who was a pioneer in outcomes management and is nationally recognized for her work. They need to understand the value that lies in using outcomes data to improve care, she says.
r It costs too much money.
Establishing an electronic medical record to capture data or purchasing outcomes management software can cost thousands of dollars, with the cost dependent on what you already have, how sophisticated your new system will be, and how large your practice is.
Of course, you can collect some information on a purely paper-and-pencil system, but you’ll need staff to score and compile the data, and you won’t have immediate results.
Another option is to contract with a consultant or outcomes management service. You would collect your outcomes information, such as the SF-36, and send the paperwork to the contractor, who would send results back.
Whatever the method, you can’t get around spending money for outcomes management.
"It’s got to be the cost of doing business," says Stevic. "The better [practices] plan for an efficient data collection, the less it’s going to cost them."
By that, Stevic means evaluating the different data collection methods and choosing the one that works for your practice, based on your information goals, staff and physician acceptance, and cost. (For more information on funding outcomes management, see story, p. 6.)
r My patients won’t like the inconvenience.
It takes patients as little as five minutes and as much as 20 minutes to fill out health status surveys. If you explain the purpose, they usually won’t mind and may even applaud your efforts.
In a pilot study of its new MODEMS outcomes management program, the American Academy of Orthopaedic Surgeons in Rosemont, IL, reported that 39% of practices said "the overall feeling of their patients was positive or very positive" toward it, and 48% of practices said their patients "seemed to enjoy the process somewhat or very much."
Let patients know their answers count
Physicians need to let the patients know how important the survey is and how it will be used to improve their care, says Stevic. "We tell patients that these measures are as important as a lab test in measuring their response to treatment," she says. "Patients in focus groups have told us that makes a big difference. It’s not just a survey for marketing or to make the company look good."
r The results will be meaningless or misused.
If you are not getting meaningful, actionable results, the flaw may be in the design of your outcomes management program not in its existence.
"[Physicians have] got to open up their souls and ask the right questions," says Chris Arslanian, PhD, RN, director of research for the Tucson (AZ) Orthopaedic Institute. That means moving beyond the safe regions that are likely to show positive performance into areas that might be less flattering.
For example, you may want to ask directly how patients feel about the phone answering system if you sense that some may not like it. And rather than just asking general questions about the nursing and medical care, you may ask patients directly, "Are you happy with your outcome?"
Some physicians worry that data showing areas of weakness could be used against them by payers or others. Yet, Arslanian believes there are benefits to sharing information openly with payers, physicians, and patients.
"We’ve been able to use the data to establish a reputation for ourselves that we’re doing it, and we’re not afraid of what the data say," she says. "It encourages a trustful relationship. We still control the data and choose the way we would like them to presented."
That is the key to an outcomes management program. You will have your own data, and you determine the collection method and the dissemination.
"If you’re not doing outcomes studies and gathering your own data, then somebody along the line is going to gather your data for you," says Arslanian. "You won’t have any control over the questions that are asked, the quality of the data, and the conclusions that are drawn from your data.
"If you’re not doing your own data collection, then you have to live with the consequences," she says.
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