1 Why Focus on Health Outcomes? a change in direction a forty one billion dollar question Inputs -...
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Transcript of 1 Why Focus on Health Outcomes? a change in direction a forty one billion dollar question Inputs -...
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Why Focus on Health Outcomes?
a change in direction
a forty one billion dollar question
Inputs - resources needed to carry out a process or provide a service
Outputs – the direct result of the interaction of inputs and processes in the system; the types and quantities of goods and services produced by a service.
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The Measurement of Output and Productivity in the Health Care Sector in Canada: An Overview (Sharpe, Bradley and Messinger)
Conclusions:Price indices for health care output may be overestimatedBetter documentation of methodologies Quality improvements are not capturedNot clear whether increased spending on health is due to higher prices or increasing quality and quantity
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What are Health Outcomes?
A measure of the effectiveness of our health care system and of the impact of public policies that influence health
The effect on health status from performance (or non-performance) of one or more processes or activities carried out by healthcare providers. USAID health and workforce improvement project
Health outcomes are used to examine the rate of death or illness (eg, the number of lung cancer deaths per 100,000 people).North Dakota health indicator glossary
A health outcome is: A change in the health of an individual, or a group of people or a population that is wholly or partially attributable to a health intervention or a series of interventions.Australian government website
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Choose outcomes that count
WHO estimates 1/3 of all social and economic costs to society are due to chronic diseases caused by tobacco, alcohol, high BP, high Cholesterol ad obesity30% of Canadian have at least one of seven high impact chronic health conditions and 1/3 of these people have multiple chronic health conditions
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Health Outcomes – the players
Public Policy Makers
Health Care System Managers
Health Care Providers
Individuals, families and communities
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How do we provide care now?
Canadians with diabetes:
< 50% get all the recommended tests and procedures that experts recommend
> 50% have poor cardiovascular health
~ 50% do not achieve recommended levels of blood sugar
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Approaches to improving quality of care include effectively measuring outcomes
Teams: Interprofessional teams and case management improve quality of care
Technology: Electronic health records, reminder and clinical-support information systems can improve quality of care and outcomes
Tools: Training and support to set and monitor goals improves quality of care
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Conclusions
Health care (not medical care) requires inter-sectoral cooperation as much as inter-provincial cooperationHealth care is a major contributor to the health of the economy and healthy communities are more viableHealth care with good outcomes is a contributor to society not a cost
We must have appropriate information systems to support health outcome assessment (Visa)Concentrate on a few outcomes with the greatest impactWe need specific assessment of individuals within communities over time
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OECD Health Status Ranking
Health Status
United States
US Rank in OECD
Canada Top Ranked
Infant mortality
6.8/1000 live births
26 5.3/1000 live births
Iceland
2.7/1000
Maternal mortality
9.9/105 births
22 4.4/105
births
Switzerland
1.4/ 105
Life expectancy from 65 yrs
19.8 yr
16.8 yr
10
9
20.6 yr
17.1 yr
Japan (23)
Iceland (18)
Adapted from We Can do Better – Improving the Health of the American People. Steven A Shroeder.Shattuck Lecture, N Engl J Med 357;12 September 20, 2007
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Number of US Deaths from Behavioral Causes, 2000 (Mokdad et al)
0
50
100
150
200
250
300
350
400
450
SexualBehavior
Alchohol MotorVehicle
Guns Drugs Obesity Smoking
Deaths/1000
We Can do Better – Improving the Health of the American People. Steven A Shroeder.
Shattuck Lecture, N Engl J Med 357;12 September 20, 2007
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Health Outcomes – Health Council of Canada
The Players Outcomes that can be affected:
Public Policy Makers Build healthy public policy
Create supportive and healthy environments
Health Care System Managers Reorient health care services to support health and prevent disease
Strengthen communities to promote health
Health Care Providers Access to needed care
Care that is coordinated, integrated and comprehensive
Individuals, families and communities
The public is engaged in their health care and patients are empowered