From Simple Process to Outcome Measures—Transforming Our Health Care Focus to Improve Patient Health

When it comes down to it—according to Dr. Joel V. Brill, medical director at FAIR Health, Inc.—the question at the heart of our health care system’s transitioning focus is “how do we improve outcomes for patients?”

Dr. Brill spoke with National Pharmaceutical Council (NPC) about the fundamental shift in how we measure quality in health care happening across the country. As Dr. Brill explains, the initial thinking around quality metrics was to evaluate our processes—that is, assessing how doctors responded to questions such as, “did a patient have a particular examination?” and “why did you recommend the examination?” However, the medical community—including Dr. Brill—began to realize that these simple process-based evaluation measures didn’t really get to the core of improving the quality and outcomes of patient care.

So as Dr. Brill and health care systems across the country began to contend with this issue, they recognized that part of the disconnect between guidelines and how to best assess patient outcomes stems from the way that measures were developed. Dr. Brill notes that by flipping this process—by first looking at the environment and the overall outcome of care, and then developing guideline measures that actually respond to these goals—we can better connect quality and guideline measures to long-term patient outcomes.

In fact, this fundamental shift in thinking has the potential to have a huge impact on the way doctors determine what types of health care examinations and treatments to provide, when to provide them, and what kind of follow-up they recommend for each patient. For example, Dr. Brill highlights how this transition could change the way doctors think about colorectal cancer screenings.

As has been reported in the news, colorectal cancer screenings were one of only five types of screenings assessed by the American College of Physicians’ High Value Care Task Force, which is working to better determine how to get the most value out of our health care system. Cancer screenings have become more commonplace among Americans; however the Task Force contends that in many cases, the way to increase the value of screening tests is to do less of them, since few screenings ultimately lead to “little loss in benefits,” but significant “reductions in harms and costs.”

In the case of colorectal cancer, since the lifetime risk of being diagnosed is only 5 percent, the remaining 95 percent of patients will see no benefit—while increasing patients’ risk of harm from unnecessary and costly procedures. That means working with doctors to ensure the right patients get the right test, at the right time, for the right conditions is becoming even more important.

As Dr. Brill explains, since a screening is obviously examining a patient in the absence of signs and symptoms, it is critical that doctors assess and reassess their decision-making around screenings to ensure we continue to improve upon guidelines that can and will be used by the health care community at large. He notes, that if physicians measure what they did and what their recommendations are through each possible patient scenario—whether or not they found something, and if so, whether it was a precancerous or an insignificant legion, how many, what type of follow-up—then we can continue to develop consensus guidelines that bring more value to the health care system and look at the environment of care and recommended follow-up.

Importantly, Dr. Brill notes, when you bring those two recommendations together, “you’re improving care for the patient and improving outcomes in a long-term basis.”