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Clinical Outcomes

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A Clinical Outcome is the health state of a patient resulting from medical / behavioral health services

1. Outcome Measures

Measuring clinical outcomes is central to accurately assessing the quality of patient care provided. Outcomes can include a vast range of health states; mortality, physiologic measures such as blood pressure, laboratory test results, functional status and symptoms, all may be used as outcome measures. Outcome measures in different contexts, such as quality improvement, public reporting, and incentive programs, are increasingly being employed because they have a direct relationship to quality of services. Although at times it is sometimes difficult to make interpretations regarding the degree to which a specific health outcome is attributable to the health care received by a patient as opposed to other factors, unrelated to health services.

Clinical Outcome – is the health state of a patient resulting from medical / behavioral health services

2. Using Clinical Outcome Measures

The need to account for all factors influencing a patient’s health outcome can be addressed by adjusting for risk factors, using statistical adjustment, or stratification of the data. These adjustments will be based ideally on the state of the patient before the patient received a particular set of health care services from the provider. The timing of measuring outcomes relative to the care received is critically important in determining a health providers’ contribution to successful patient outcomes. Users of outcome measures may wish to consider other important technical questions. For instance, is the population and sample size adequate to draw appropriate conclusions regarding clinical quality?

Outcomes measures can be very useful in quality improvement programs, by pointing out the areas in which treatment interventions could improve present levels of care. For Instance, less favorable treatment outcomes could result from patients’ delays in recognizing symptoms, or delays in patient assessment and treatment. Improvement efforts can then be targeted in the areas where improvements might yield the best cost effective results. For instance, patient delays might be addressed with community-based education and improved internal communications processes aimed at earlier interventions. Given the technical difficulties and costs associated with collecting health outcomes data from patients directly, many organizations have moved to automated measures including adapting the internet to regularly allow patients direct access to computer evaluation systems. This process has lowered costs of data input, improved patients ability to directly impact the quality of care by defining their treatment needs and has in some cases reduced the amount of time actually spent in treatment.

Increasing the frequency of patient evaluations has also had the effect of reducing patients leaving the program against medical advice. With such a system in place there is a constant check on many reasons other than the health status patients may leave programs against medical advice. Absent an effective evaluation system in place clinicians’ may be slow to recognize why a patients’ health and attitude toward treatment is deteriorating. Issues, such as a lack of aftercare services, affordable housing, family problems, work related concerns or a misjudgment about the discharge plan can often linger below the surface and go unnoticed.

3. Questions When Selecting Outcome Measures

  1. Are your outcome measures going to be utilized for both quality improvement and accountability?
  2. What points in the treatment process is health care progress measured and documented?
  3. When are the patient treatment outcomes to be measured?
  4. What organizational and non-health care factors might be influencing the relationship between process of care and the outcome?
  5. Have the treatment objectives, professionals and other services been clearly enough defined?
  6. In particular, are there staff who have been directly involved in the observed outcome?