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Health System Goals and Measurement

Health System Goals and Measurement. PA 574: Health Systems Organization Session 3 – April 17, 2013. What Goals - What Measurement?. Intrinsic Goals: Relatively independent of other goals More is always better Hard to find Instrumental Goals: Often interdependent with other goals

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Health System Goals and Measurement

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  1. Health System Goals and Measurement PA 574: Health Systems Organization Session 3 – April 17, 2013

  2. What Goals - What Measurement? • Intrinsic Goals: • Relatively independent of other goals • More is always better • Hard to find • Instrumental Goals: • Often interdependent with other goals • More not always better • Indirect to “desired” goal • Common but numerous and imperfect

  3. Where Have We Been – Where Are We Going? Struggle to find simple, informative system goals Striving for single, intrinsic goal measure has led to important realizations and goal/measurement thinking (WHO, etc.) Recognition that a set of instrumental goals related to “true” goal is likely best Some of the points along the way….

  4. Institute of Medicine Six Aims/Ten Rules • Six Aims • Safe • Effective • Patient-centered • Timely • Efficient • Equitable • Ten Rules for System Redesign…

  5. Institute of Medicine Ten Rules for System Redesign • Care is based on continuous healing relationships; • Care is customized according to patient needs/values; • The patient is the source of control; • Knowledge is shared and information flows freely; • Decision making is evidence-based; • Safety is a system property; • Transparency is necessary; • Needs are anticipated; • Waste is continuously decreased; and, • Cooperation among clinicians is a priority.

  6. Access, Cost and Quality • Note: All three are instrumental… • Access: • Availability • Opportunity • Knowledge (e.g. health literacy)? • Quality: • Better health related outcomes? • Other things e.g. convenience? • From who’s perspective? • Cost: • Yes..but is this perhaps the most instrumental…

  7. WHO 2000 • Three intrinsic goals… • Population Health • Yes..but overall, in distribution..that easy.. • Fairness in Financial Contribution • Macro issue about how resources collected • Does this speak to level of expenditure? • Responsiveness to People’s Expectations in Regards to non-Health Related Matters • Multi-dimensional • Culturally divergent? • Why non-health?

  8. The Triple Aim (IHI/Berwick, Nolan & Whittington, 2008) • Where we are now…. • Goals: • Improving the experience of care • Improving the health of populations • Reducing per capita costs of health care • Preconditions: • “Enrollment” of population • Commitment to universality • Role of “integrator”

  9. The Triple Aim Intrinsic or instrumental?? Leave out some high macro concerns e.g. fairness of contribution??? Can be acted on globally and locally – perhaps a key element.. Basis of most “new” system and care transformation – Primary care homes, Accountable care organizations, etc..

  10. Five Responsibilities of the “Integrator” in the Triple Aim • Partner with individuals/families • Redesign of primary care • Population health management • Financial Management • System integration at macro level

  11. Levels of the Health Care System (Berwick, 2002) • Level 1: Patient and Community • Experience of patients • Level 2: Microsystem • Functioning of small units of care delivery • Level 3: Organization • Functioning of organizations that house microsystems • Level 4: Environment • Policy, payment, regulation, accreditation • Shapes behavior, interests and opportunities of Level 3 organizations

  12. Measuring Goals • Donabedian: • Structure,Process,Outcome • Structural measures easiest – how much stuff do we have • Process Next – what did we do • Outcome Best but Hardest – first two are instrumental • Striving to get here…

  13. Measuring Goals • Population Health: • Disability or quality adjusted life years (DALYs/QUALYs) • Amenable Mortality • Distribution of health states e.g. percentage of population considered obese • Process measures (health as “quality”): • NCQA/HEDIS process measures • Ambulatory Care Sensitive Admissions • All Cause Re-admission

  14. Measuring Goals • Experience of Care • Consumer Satisfaction (?) • Timeliness • Safety • Cultural Competence • Patient-centeredness • Reducing Per Capita Costs • Population level – note this needs “population”

  15. Measuring Goals Well lets look at some international comparative measurements…..

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