This presentation, by Professor Eugene Nelson from the Dartmouth Institute, looks at measuring what matters to patients and some specific case studies and examples. To view a video of the presentation with sound/narrative, go to: http://www.health.org.uk/multimedia/slideshow/measuring-what-matters-to-patients-concepts-and-cases/

1. Measuring what matters to patients:
concepts & cases
The Health Foundation
Improvement Science Development
Group
January 7, 2013
Eugene C. Nelson, DSc, MPH
The Dartmouth Institute
Dartmouth-Hitchcock Health System
Wayne Gretzky
Acknowledgements: J. Weinstein, R. Reid, S. Lindblad, J. Wasson, C. Kerrigan, J.
Kirk, P. Batalden, et al and financial support from The Dartmouth Institute, The
Dartmouth Center for Healthcare Delivery Science, the Robert Wood Johnson
Foundation, PCORI and NIH-NIA.

2. Short
Answer
Value:
Gretzky Group: Health Affairs 2013
Outcomes
+
Experiences
+
Costs
2

3. Aim: measures to support co-production
of health* & health care in microsystems**
At risk
New condition
Clinical Microsystem
Recover/Reduce Burden
Person
Co-Production
Clinician
Key Patient Outcomes
Experience
Function
Disease
Key measures
Risks
Costs
Competence
Health Determinants*
• Genetics
• Environment
• Lifestyle
• Health care
** Clinical microsystems, i.e., the place where patients and providers meet and interact for the benefit of patients (12)

4. Case 1
An old story … great clinical results &
better functional outcomes …
because of functional screening
JAMA 1983
Insert JAMA article
x
Jack Kirk, MD
Founder
Dartmouth COOP Project
4

5. Case 2
Using PROMs with Individuals:
Dartmouth Spine Center
Feed Forward
Referral
or Visit
Request
Orientation
&
PROMs
Acute
Care
Management
Initial
Work Up
Plan of Care
Chronic Care
Management
Functional
Restoration
People with
healthcare needs
Palliative
Care
Functional &
Risk Status
Disease
Status
Expectations
For Good Care
Sunk
Costs
Feedback
 Improvement registry
 Public reports website
 SPORT & research
© 2000, Trustees of Dartmouth College, Batalden, Nelson, Wasson
People with
healthcare
needs met
Functional &
Risk Status
Experience
Against
Need
Disease
Status
Incremental
Costs
5

6. The summary report generated from patient-reported data is critical to
a physician's ability to care for a patient: same page care
Functional
Status
Red Flags
Risk Status
“practicing without it …flying a plane without instruments”
Disease
Status
History &
Symptoms
Patient Perception of Outcomes

7. Physical SF-36
Improvement
Herniated Disk
Outcomes @ 2 Years
Surgery
44 Ave Age
43% Female
Cost Per Quality
Adjusted Life Year Added
By Surgery $34,355
Non-Surgery
30 Ave Age
45% Female
44
30
My risk calculator
Functional
Clinical
Reduced
Oswestry
Symptoms
1.64
QALY
1.44
QALY
$74,870
$34,355
-25
Moving research results
back to patient care …
risk calculator
used at point of care
for Shared Decision
Making about likelihood
of outcomes based on
different treatments
78%
Satisfaction
-37
Satisfied With
Improvement
59%
Costs
$13,108
$27,341
Total Direct &
Indirect Costs

8. Case 3
•
Sweden: Rheumatology
Quality Registry (SRQ)
SRQ uses PROMs feed forward data in
flow of care: better care for individuals,
practice improvement, new care models,
retrospective & prospective research &
better measured outcomes for Sweden
RA patients
Staffan Lindblad, MD
8

9. Dashboard for a
Rheumatology
Patient
January - March
Functional Outcomes
Clinical Outcomes
Swedish National
Quality Registry …
patient is
doing better …
N of 1 experiment…
Responded to biologics
June - December

10. By the way … Swedish health system is doing better
All Patients in the SRQ, from 1994 – 2006*
Patients sicker at 1st visit
From front line practice
to national policy
Patients better at 12 months
*Black line shows DAS at initial visit and blue after 6 months and turquoise after 12 months.

11. Amy
My
Health
Status
What measures matter most to patients
at the front lines is DYNAMIC
My
Healthcare
Decisions
My
Healthcare
Plan
My
Health
Outcomes
Patient Reported Metrics + Clinical Metrics =
Guidance System for Getting It Right …
•Health care decisions right for Amy
•Health care plans right for Amy
•Health care outcomes best for Amy
•Thus, Amy is able to co-produce her care
11
Case 4