OUTCOME-DRIVEN CHANGE

All planned change has an end goal: a specific outcome the planner hopes to achieve. An outcome-driven approach concentrates on specific, measurable objectives to determine the impact a treatment or intervention has on the health of a patient or groups of patients (Harvard Catalyst, 2018).

For example, suppose a patient is working on losing a total of 50 pounds, which can sound overwhelming. An outcome-driven approach might employ agreeing with the patient on a measurable outcome, such as “lose 1–2 pounds a week for a total of 4–8 pounds before the next office visit in one month.”

Outcome Measures

The top seven healthcare outcome measures are linked to behavioral change. If patients do not adopt healthy behaviors, any one of the following outcomes can be compromised. These seven outcome measures are:

  1. Mortality. Failure to comply with treatment regimens can lead to an increase in mortality rates.
  2. Safety of care. Safety, in the instances of desired health-related behavioral changes, can be linked to education. Although healthcare professionals cannot “make” patients adopt important behavioral changes, they are responsible for making sure appropriate information is relayed and for objectively evaluating patient/family knowledge.
  3. Readmissions. Readmission because of noncompliance is a significant problem. Research suggests that in one year, $25–$45 billion is spent on avoidable complications and unnecessary hospital admissions.
  4. Patient experience. Patient-reported outcome measures (PROMs) are not only an important indicator of satisfaction with services but can provide information about how well patients were taught about their treatment regimens.
  5. Effectiveness of care. Effectiveness of care includes compliance with best-practice guidelines and actual achieved patient outcomes.
  6. Timeliness of care. Timeliness-of-care outcomes evaluate patient access to care. This includes not only how quickly adequate care is provided but also how effective patient education has been. In other words, did patients (and families) receive the necessary education to make appropriate behavioral changes in a timely manner?
  7. Efficient use of medical imaging. Although not directly related to behavioral change, efficient use of medical imaging indicates adherence to best-practice standards.
    (Tinker, 2022)

Three essentials for successfully measuring healthcare outcomes are:

  • Data transparency. Publicly reported healthcare outcomes help to show that patients are receiving the best care in the most cost-effective way.
  • Integrated care and transitions of care. Patient transitions throughout the healthcare system should be coordinated. All members of the healthcare team are responsible for managing quality care and providing safe and appropriate care at all transitional points of care.
  • Data interoperability. Sharing data between departments is essential. Achieving outcomes and system improvement depends on ability to share data across clinicians, labs, hospitals, clinics, staff, etc. Data interoperability provides a single source of truth.
    (Tinker, 2022)
CASE

An Outcome-Driven Approach

Jim just learned he has type 2 diabetes. He knows nothing about diabetes and until now has paid little attention to his diet or health. Jim’s healthcare provider gives Jim several pamphlets about diabetes, refers him to a diabetes website, and suggests he attend classes offered by the local hospital. Though Jim reads the brochures and information he finds on the website, he does not understand how to apply it to his condition, nor does he grasp the importance of monitoring blood glucose levels. He is afraid of blood and needlesticks and therefore inconsistent in monitoring his blood glucose. He is also uncertain about what to do if readings are abnormal.

When Jim attends a diabetes education class at the hospital, he realizes he needs much more information as it applies to his own personal situation. He shares his fears and confusion, and he asks the diabetes educator leading the class for help. The educator agrees and consults with Jim’s physician. During a follow-up appointment, the diabetes educator identifies Jim’s barriers and specific, measurable objectives to help Jim meet his diabetes learning needs (outcome-driven approach).

One of the objectives they agree upon is “Jim will accurately perform a blood glucose test, 100% of the time.” The educator explains the reason for the test and its relevance to Jim’s disorder. She encourages him to talk about his concerns and feelings about blood glucose monitoring. Then, she demonstrates how to accurately monitor blood glucose levels, what normal target ranges are, and what to do if levels are abnormal. Jim mirrors her demonstration until he can do it accurately. He also participates in role-playing examples of what to do for various abnormalities if and when they occur.

Discussion

The diabetes educator, acting as a change agent, linked the rationale for performing a blood glucose test to Jim’s disease and diet, further motivating Jim to change his behaviors. In doing so, the educator helped Jim to develop an outcome-driven approach that:

  • Clearly states each specific, measurable objective (i.e., Jim will accurately perform a blood glucose test 100% of the time)
  • Identifies barriers to changing behavior (i.e., Jim admits that he is afraid of blood and the pain associated with a needlestick)
  • Looks for specific items and behaviors to facilitate change in the patient (i.e., the educator shows Jim how to use the blood drawing equipment to reduce the amount of blood drawn and the degree of pain felt with repeat tests)
  • Arranges follow-up to help the patient maintain newly acquired healthy behaviors (i.e., the educator schedules regular clinic visits for Jim and enrolls Jim in a diabetes self-management program)

Outcome-Driven Approach for Healthcare Systems

In 2014, the Quadruple Aim (adapted from the Triple Aim) was developed as a model to optimize the performance and productivity of healthcare systems. The Quadruple Aim focuses on improving:

  • Healthcare costs
  • Patient experience
  • Population health
  • Healthcare team well-being
    (Arnetz et al., 2020)

Experts are now considering adding a fifth aim of advancing health equity, which is defined as “the state in which everyone has the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances.” In order to effectively address this fifth aim, change is also necessary. This change focuses on the development and implementation of evidence-based interventions to identify and reduce disparities (Nundy et al., 2022).