Use Of Outcome Data Research Articles

The use of outcome data from quality registries to learn and improve; a Dutch nationwide quantitative analysis in five disease areas

BackgroundClinical quality registries (CQR) aid in measuring, collecting and monitoring outcome data but it is still unknown how these data are used by hospitals to improve the quality of care. This study assessed the current state of outcome-based quality improvement in the Netherlands in 2022 based on data from multiple disease areas and CQRs; cardiothoracic surgery (Netherlands Heart Registration [NHR]), cardiology (NHR), nephrology, (Nefrovision), intensive care (National Intensive Care Evaluation [NICE]), and orthopaedic surgery (Dutch Arthroplasty Register [LROI]).Methods & resultsThe Health Outcomes Management Evaluation (HOME) model was used to assess the current state of outcome-based quality improvement. A questionnaire with 36 questions was sent to healthcare departments of the six disease areas in participating hospitals within five quality registrations in the Netherlands. In total, 124 responses were received; 20 within cardiology, 12 within cardiothoracic surgery, 30 within nephrology, 35 within intensive care and 27 within orthopaedic surgery. Results showed outcome measures were actively used to improve the quality of care, several improvement initiatives were implemented, but outcomes were not always monitored regularly. Results differed between hospitals, but differences were limited between disease areas.ConclusionThe current state of outcome-based quality improvement in all five disease areas is that outcome measures were consequently employed and used on a frequent basis aiming to achieve quality improvement in healthcare. Results can be improved by structurally embedding the entire improvement cycle into the organisation.

Moral Injury in K-12 Education: A Phenomenological Inquiry at the Intersection of Race and Class

This study is a phenomenological exploration of moral injury among K-12 professionals who work in schools in which the large majority of students are students of color and are eligible for free or reduced lunch. All participants worked in one urban school district in the Midwest of the United States. Professionals identified harsh discipline practices, insincere restorative justice programs, deceptive use of outcome data, and a pitying approach to the education of low-income students of color as morally injurious practices. The paper ends with recommendations for how the construct of moral injury can be useful in identifying and confronting sources of educational injustice.

The use of outcome data in patient consultations from the healthcare professionals’ and patients’ perspectives: A mixed methods study

ObjectivesTo gain insight into healthcare professionals’ (HCPs’) perspectives on the use of outcome data in consultations and to understand which aggregated outcomes patients find important. MethodsThis study had a mixed-methods design and consisted of two steps:1.HCPs (n = 11) were interviewed about the use of outcome data in consultations. Thematic analysis was used for data analysis.2.Patients with prostate cancer, lung cancer, and inflammatory bowel disease (IBD) completed questionnaires (n = 283) to identify important outcomes. Descriptive statistics were used for data analysis. ResultsHCPs indicated that aggregated outcome data are not routinely used in consultations. They pointed out various barriers to using outcome data, e.g., low response rates of PROMs, and suggested actions to address these barriers, including training of HCPs in outcome data usage. Patients rated the majority of aggregated outcomes as important, although preferences differed between the studied health conditions. ConclusionBoth HCPs and patients underscored the importance of discussing outcome data in consultations. Nevertheless, HCPs encountered several barriers to using outcome data. Furthermore, patients with different health conditions have somewhat different information needs. Practice implicationsThe study identified several actionable steps to enhance the collection and application of outcome data in consultations.

Effectiveness and implementation of SHared decision-making supported by OUTcome information among patients with breast cancer, stroke and advanced kidney disease: SHOUT study protocol of multiple interrupted time series

IntroductionWithin the value-based healthcare framework, outcome data can be used to inform patients about (treatment) options, and empower them to make shared decisions with their health care professional. To facilitate...

962-P: Interim Real-World Ten-Site Data from the National Danish PRO Diabetes Multisector Study (M-PRODIA) Engaging 460 Persons with Diabetes and 30 Health Care Professionals Shows High Acceptability and Benefits

Introduction: A national value-based health care project, VBHC-PRO-DIA, was initiated in 2017 to develop and evaluate a scalable solution for value based diabetes care in Denmark. Our project was undertaken in partnership and alignment with a national PRO diabetes program. We present the study design for this national project. Materials and Methods: A participatory multi-stakeholder research design process 2017-2020 with systematic involvement of > 70 PWD using interviews, workshops, clinical & qualitative research: 1) A minimal patient-important diabetes outcome domain set (VBHC structure) . 2) A unified PRO diabetes “logic model” for how to use PRO to drive health value. 3) A national psychometric PRO Diabetes Questionnaire & Decision-Algorithm. 4) A VBHC-PRO IT Tool for seamless use of outcome data in routine diabetes care. 5) A multi-center real-world PRO pilot study of public health potential (RE-AIM) . 6) Implementation planning, data-driven VBHC model design and effectiveness study. Results: National PRO Model: PWD fills out PRO before visit. PRO is used in-visit for collaborative, focused, whole-person care. A multi-dimensional PRO questionnaire (36-70 items) covering: General health/wellbeing, daily life with diabetes, diabetes distress, self-care, BG regulation, symptoms, access to care, personal goals and priorities. Real-world 10-site PRO study : Interim data: > 460 PWD/ 30 HCPs showed high acceptability and experience of benefits related to active engagement of PWD and person-centred diabetes care quality. Disclosure N.Ejskjaer: None. P.H.Kjaer: None. D.B.Berthelsen: None. S.H.Kaplan: n/a. P.O.Jakobsen: None. C.Glümer: n/a. S.E.Skovlund: Consultant; Roche Diabetes Care.

Perceptions of private practice dietitians regarding the collection and use of outcomes data in primary healthcare practices: A qualitative study.

Dietitians working in private practices in primary settings provide nutrition care to support individuals with the prevention and management of chronic disease. A better understanding of the type and usage of data collected by dietitians in this setting may provide insights to optimise the effectiveness and impact of the workforce. The present study explored the perceptions of leading Australian private practice dietitians on the collection and usage of data in their practice. A qualitative descriptive study of Australian private practice dietitians, recruited by snowball sampling, was conducted on their perceptions and attitudes towards collecting and using data. Data were collected by semi-structured interviews and all interview data were thematically analysed. Twenty-three dietitians participated. Five themes emerged: (i) collecting data is challenging, nuanced, unclearly defined and therefore not routinely carried out; (ii) consistent data collection processes are impeded by the diversity of practise and practices; (iii) business-related data collection is essential for sustainable dietetic services; (iv) clinical outcomes are fundamental to dietetic services; and (v) standardised, integrated systems are needed to enable routine data collection and synthesis. Our findings demonstrate the rudimentary role business acumen has in practice viability and provides evidence to potentially re-shape the future of dietetic education in Australia. Private practice dietitians may benefit from tools and training that enable consistent collection of data about their services. Such data could enable benchmarking across the workforce and contribute to a broader understanding of dietetic impact on public health.

Creating a Practice-Based Implementation Network: Facilitating Practice Change Across Health Care Systems.

A proof-of-concept practice-based implementation network was developed in the US Departments of Veteran Affairs (VA) and Defense to increase the speed of implementation of mental health practices, derive lessons learned prior to larger-scale implementation, and facilitate organizational learning. One hundred thirty-four clinicians in 18 VA clinics received brief training in the use of the PTSD checklist (PCL) in clinical care. Two implementation strategies, external facilitation and technical assistance, were used to encourage the use of outcomes data to inform treatment decisions and increase discussion of results with patients. There were mixed results for changes in the frequency of PCL administration, but consistent increases in clinician use of data and incorporation into the treatment process via discussion. Programs and clinicians were successfully recruited to participate in a 2-year initiative, suggesting the feasibility of using this organizational structure to facilitate the implementation of new practices in treatment systems.

How Have ACA Insurance Expansions Affected Health Outcomes? Findings From The Literature.

A growing body of literature examining the effects of the Affordable Care Act (ACA) on nonelderly adults provides promising evidence of improvements in health outcomes through insurance expansions. Our review of forty-three studies that employed a quasi-experimental research design found encouraging evidence of improvements in health status, chronic disease, maternal and neonatal health, and mortality, with some findings corroborated by multiple studies. Some studies further suggested that the beneficial effects have grown over time and thus may continue to grow if the ACA insurance expansions remain in force. However, not all studies reported a significant positive relationship between ACA provisions that expanded insurance coverage and health status. We highlight the challenges facing researchers, including the importance of nonmedical factors in determining individual health and the use of outcome data predominantly drawn from self-reports. In closing, we identify opportunities to enhance researchers' understanding of the relationship between the ACA insurance expansions and health outcomes using new data sources, including electronic health records.

Implementing Same-Day Discharge After Hysterectomy Within a Large, Multi-Hospital Healthcare System [1L

INTRODUCTION: Same day discharge (SDD) for minimally invasive hysterectomies (MIH) often promises to save healthcare resources and improve satisfaction among patients and providers. Previous studies established the safety of SDD, however data are limited on how to effectively integrate SDD programs in heterogeneous healthcare systems consisting of tertiary care centers and smaller community hospitals. The goal of this work is to describe the implementation of a SDD process within UPMC--a large, multi-hospital health system in Pennsylvania. METHODS: Implementation of SDD was studied through stakeholder interviews including surgeons, nurses, and administrators. Participants were asked about the development and implementation of the SDD program including facilitator and barrier factors at 20 hospital of various sizes, with sub-specialists as well as general gynecologists. To determine the best course for integrating SDD, small multidisciplinary working groups were established with representatives from relevant departments. University of Pittsburgh IRB approved this work. RESULTS: System development of the program included formation of evidence based guidelines, development of protocols, hiring of a nurse concierge, quality checks, SDD pathway introduction into EMR, surgeon performance dashboards, incentives for following the pathway, etc. The program was piloted by a small group of surgeons, followed by integration within the wider UPMC community. Provider buy-in was encouraged through surgeon education and the use of outcomes data. SDD program resulted in considerable reduction in overnight stays associated with hysterectomies. CONCLUSION: It is safe and feasible to implementing a SDD program for MIH within a heterogeneous health care system through a multi-step process of providing processes, systems, and education.

Quality and Value of Health Care in the Veterans Health Administration: A Qualitative Study.

BackgroundThe attitudes of Department of Veterans Affairs (VA) cardiovascular clinicians toward the VA's quality‐of‐care processes, clinical outcomes measures, and healthcare value are not well understood.Methods and ResultsSemistructured telephone interviews were conducted with cardiovascular healthcare providers (n=31) at VA hospitals that were previously identified as high or low performers in terms of healthcare value. The interviews focused on VA providers’ experiences with measures of processes, outcomes, and value (ie, costs relative to outcomes) of cardiovascular care. Most providers were aware of process‐of‐care measurements, received regular feedback generated from those data, and used that feedback to change their practices. Fewer respondents reported clinical outcomes measures influencing their practice, and virtually no participants used value data to inform their practice, although several described administrative barriers limiting high‐cost care. Providers also expressed general enthusiasm for the VA's quality measurement/improvement efforts, with relatively few criticisms about the workload or opportunity costs inherent in clinical performance data collection. There were no material differences in the responses of employees of low‐performing versus high‐performing VA medical centers.ConclusionsRegardless of their medical center's healthcare value performance, most VA cardiovascular providers used feedback from process‐of‐care data to inform their practice. However, clinical outcomes data were used more rarely, and value‐of‐care data were almost never used. The limited use of outcomes data to inform healthcare practice raises concern that healthcare outcomes may have insufficient influence, whereas the lack of value data influencing cardiovascular care practices may perpetuate inefficiencies in resource use.

Multidisciplinary teams and ICT: a qualitative study exploring the use of technology and its impact on multidisciplinary team meetings

BackgroundMultidisciplinary teams (MDTs) are an integral component in the delivery of health care. This is particularly evident in the delivery of cancer care, where multidisciplinary teams are internationally recognized as the preferred method for service delivery. The use of health information systems and technology are key enabling factors for building the capacity of MDTs to engage in improvement and implementation projects but there is scant research on how MDTs make use of technology and information systems or the kinds of systems needed for them to undertake improvement and implementation research. This paper reports findings on how seven MDTs in cancer care utilized technological and information systems and the barriers and enabling factors that impacted on their uptake.MethodsSeven multidisciplinary teams from two large metropolitan hospitals participated in the study. Qualitative methods including structured observations and semi structured interviews that explored how teams engaged in research and improvement activities were utilized. Participants were also observed and interviewed in relation to their use of data and health information systems. Findings were subject to content analysis and key themes were identified. Interviews were transcribed and de-identified and key themes were subsequently discussed with participants to allow for member checking and further clarification of findings.ResultsA total of 43 MDT meetings across seven tumor streams were observed. Of these, observation notes from 13 meetings contained direct references to emerging technologies and health information systems. Findings from 15 semi-structured interviews were also analyzed in relation to how MDTs used technology in weekly meetings, and the perceived impact of technology. Three broad themes emerged: (1) methods for data collection and use by MDTs, (2) the impact of technology on the MDT meeting environment, and (3) the impact of technology and information systems on clinical decision making.ConclusionThe study demonstrates that real time data collection and imaging may improve patient centered care coordination. However, ICTs can be used sub-optimally by teams. We therefore urge additional research to identify the enabling factors that support better collection and use of outcome data from ICT.

New outcome measures in perioperative care.

Improvements in outcome measurement are needed to produce quality improvement in perioperative care. However, problems with the collection and use of outcome data persist in research and clinical practice. This is being addressed by several national programmes and initiatives to standardize and integrate outcome measurement. The use of different outcome measures is changing and there has been a transition towards patient-focused measures. Traditional measures of quality in perioperative care include mortality, morbidity and resource utilization measures. Patient-focused measures include patient-reported outcome measures and measures of patient experience. Each of these has advantages and disadvantages in different situations. The routine collection, analysis and dissemination of data relating to perioperative outcome is beneficial to patients, clinicians, hospitals, commissioners, regulators and researchers.

Capsule Commentary on Rana et al., Diabetes and Prior Coronary Heart Disease Are Not Necessarily Risk Equivalent for Future Coronary Heart Disease Events.

T he prevalence of diabetes mellitus (DM) has risen dramatically over the past decades as obesity rates have increased in the United States. Recent estimates suggest that approximately 9 % of the U.S. population, or over 29 million Americans, have DM, with the great majority having Type 2 DM. While cardiovascular disease is known to be the leading cause of death among those with diabetes, there has been controversy as to whether prevalent diabetes portends the same risk for future cardiovascular events as prevalent coronary heart disease (CHD). Delineating diabetes as a CHD equivalent or a CHD risk factor is critical to improving the accuracy of cardiovascular risk prediction and in developing tailored risk reduction strategies. Rana and colleagues analyzed electronic health record data from the Kaiser Permanente Northern California health care system, which includes over 1.5 million members. This study demonstrated that the risk of a CHD event over a 10-year follow-up period was significantly lower for those with diabetes alone as compared to those with prior CHD; these findings appear to refute previous data showing that prevalent diabetes is a CHD equivalent. Most interestingly, those with diabetes for the longest duration, or for ten or more years in the cohort, had a similar risk of CHD events as those with CHD alone. The findings are robust, given that much of the prior data examining diabetes as a CHD risk equivalent comes from metaanalyses with inherent methodologic limitations, and this study was done in a large, ethnically and racially diverse population from a real-world setting. Additionally, sex-stratified analyses of CHD event rates in this population help to identify whether CHD risk based on prevalent diabetes differs betweenmen andwomen. One area for future work with this study cohort would be to evaluate differences in CHD event rates across racial and ethnic groups among those with diabetes and/or CHD as compared to those without either disease. Overall, these findings support the use of outcomes data from diverse patient populations for creating and refining cardiovascular risk prediction models, as was used in the creation of the 2013 ACC/AHA cardiovascular risk estimator. The author has no conflict with any of the material in this manuscript. Funding support for the author is provided by the Division of Intramural Research of the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH). The views expressed in this manuscript are those of the author and do not necessarily represent the views of the National Heart, Lung, andBlood Institute; the National Institutes of Health; or the U.S. Department of Health and Human Services.

From ‘reckless’ to ‘mindful’ in the use of outcome data to inform service-level performance management: perspectives from child mental health

In the recent report on patient safety in the National Health Service (NHS) in England, Don Berwick calls on the NHS to align the necessity for increased ‘accountability’ with the...

24: Use of outcomes data to determine fetal growth standards

Extremes of fetal growth are universally recognized as determinants of perinatal morbidity, and screening for aberrant fetal growth is a standard component of routine obstetric practice. Nonetheless, criteria for discerning normal from abnormal growth are crude and arbitrary. By convention, SGA or LGA thresholds are set at the 10th and 90th centile in a population distribution of birthweight, and are not determined by clinical risk thresholds or outcome data. Fractional polynomial regression permits estimates of risk along all values of continuous predictor variables, without assumptions of linearity or constant slope.

The Multiple Uses of Routine Mental Health Outcome Measures in Australia and New Zealand: Experiences From the Field

The aim of this paper is to describe the way in which particular Australian and New Zealand mental health services are making use of routine outcome data to foster clinical improvements for consumers. We invited individuals who are responsible for implementing outcome data collection across the two countries to describe exemplary practices occurring within their own services, and present the resultant information in the form of case studies. Outcome measurement is being used to guide clinical decision-making, engage consumers in treatment, foster a collaborative approach to care planning and goal setting, review consumers' progress with treatment, inform questions about consumers' eligibility for given programs, assist with discharge planning, improve the evidence-base on which services are founded, and evaluate particular models of service delivery. A number of mental health services are deriving useful information from routine outcome measurement, and using this to guide clinical practice. The examples provided here may offer some lessons for other services wishing to make better use of outcome data, and there may be some opportunities for the sharing of resources or infrastructure. Services that are already using outcome data to inform their clinical activities, and services that are keen to do so, will need ongoing support.

Use of Outcomes Information in Child Mental Health Treatment: Results From a Pilot Study

This study examined parents and clinicians' use in treatment sessions of routinely collected information on child functioning for children receiving ambulatory mental health treatment. Information was obtained from 1,215 Child Outcomes Surveys completed at ten provider organizations. The Child Outcomes Survey is a collaboratively developed brief strength-based measure of child functioning and therapeutic relationship. This study examined parent-clinician discussion of information obtained in the survey from the previous session. Chi square tests were used to examine the association between sociodemographic and clinical covariates and parent-clinician discussion of information. In the measure that assessed the extent to which parents discussed the information about their child's functioning in the prior session with their clinician, 61% of parents reported high levels of discussion, 25% of parents reported moderate levels of discussion, and 14% reported low levels of discussion. Parents of boys, Latino children, and children of "other" races were significantly more likely to report high levels of discussion than other parents. Levels of discussion about the results of the previous Child Outcomes Survey were positively and significantly associated with successful child functioning and therapeutic relationship with clinicians. The findings of high rates of use of outcomes data routinely gathered with a very brief measure are encouraging given prior reports of challenges in using such information in treatment sessions. The successful treatment of children and families requires an ongoing and effective partnership between parents and clinicians, and the results suggest how important routine conversations about the progress of children in treatment can be. Further research is needed to understand the impact of gathering and using such data on the process and outcomes of mental health treatment for children and families.

Using Outcome to Improve a Career Development Course: Closing the Scientist-Practitioner Gap

The use of outcome data can serve as an important catalyst for improving career interventions. A follow-up to the Reese and Miller study was conducted over a 2-year period to assess whether modifications made to the course using the Reese and Miller data as a baseline resulted in subsequent improvements. Using a prepost group design that compared students in a career course designed for deciding students to a quasi-control group, data from modifications in the first year demonstrated a large increase in effect size (from 0.55 to 1.09) on a measure of career decision-making self-efficacy. The improvements in the course were maintained the second year (0.90). Uneven improvement, however, was found on a measure of perceived career difficulties from baseline. An overview of the modifications made to the course and the implications for incorporating outcome data in the provision of career services are discussed as are considerations for future research.

Party conferences: shaping the debate

In autumn and for the second year running, the College participated in a full programme of events at all three political party conferences. Central to this was a series of seminars organised by the College on the collection and use of outcome data, which brought together key stakeholders from across the parties and the wider health sector. These meetings provided an ideal setting in which to launch a new policy briefing on this significant topic.

Performance management and the Royal Colleges of medicine and surgery

Performance management and the Royal Colleges of medicine and surgery