Improving Outcome Of Treatment
HOW TO IMPROVE OUTCOME OF TREATMENT
Why is it important to improve outcome of treatment? The answer to this question may be the most important one in the life of a physician.
Outcome of a disease means the final result of treatment. Whether the treatment has resulted in full recovery or only partial recovery. For a surgeon it also means whether there has been anaesthesia or surgery related complications in postoperative period. From the administrative point of view it would include patient safety considerations including drug reactions, patient falls, wrong drug prescription etc.
Today healthcare in advanced countries is moving towards outcome based evaluation of individual diseases treatment by individual or team of physicians and surgeons. The result of treatment of individual diseases as treated by individual physicians or hospital teams is recorded and disseminated every year. There is competition between hospitals in USA based on good results of dialysis, cardiac bypass surgery, appendicectomy etc. This information is disseminated by the National health service and enables individual patients of diseases to choose the hospital with the best outcome for that disease.
GENESIS OF OUTCOME BASED COMPETITION
The healthcare system in USA is privatized and based on insurance, Hospitals would give deep discounts to payors and employers that had large overall population at the expense of individual payors, Insurance companies also would sign up low cost members who are healthy to get premium without sustaining any expense. The members moreover would be given a limited number of hospitals to go for treatment thus limiting competition. Many insurance companies would restrict access to particular services thus shifting cost of treatment to the patient.
All the above processes reduced cost to hospitals or insurance companies by shifting cost burden to the patient.
METHODS TO INCREASE VALUE OF CARE
Today competition based on outcome of treatment has caused shifting of effort to give better outcomes at reasonable cost by hospitals , insurance companies and physicians, Teams with good results will be identified and favoured by patients for particular diseases. This will benefit patients, good physicians and also increase value in healthcare system.
The first requirement to improve value in healthcare is selectivity of diseases by the physicians and hospitals. The basic cause of poor outcome for diseases is that hospitals are treating all types of diseases without developing specialization in a few. The example of Shouldice hospital in USA where doctors are operating only on hernia and by only one method , the shouldice technique, with best result in hernia surgery in the world.
The second criteria for success is outcome measurement of a disease by a treating physician or hospital which is risk adjusted for complicated presentation and comorbidities. This outcome has to be compared to results of other hospitals treating the same disease if data is available. Otherwise the data has to compared to own result over a period of time to see the trend. Here the role of information technology and computers comes in handy to save time.
Lastly outcomes will improve only with knowledge of evidence based diagnosis and treatment of a disease. This knowledge has to be standardized by best practices and clinical pathways and updated continuously. Treatment processes which are based on latest evidence and consistently applied leads to better outcomes.