Tracking outcomes in health, patient education
February 1, 1998 3 minutes read
Tracking outcomes in health, patient education
Are you measuring to measure or to improve?
Women devour health teaching when the subject pertains to their concerns. Still, if you can’t show solid health improvements from those services, support for them will dwindle with each budget cycle. Unfortunately, great attendance and glowing feedback hold little sway as bonafide outcomes in the eyes of finance officers. Don’t chuck those feedback forms yet, though, because they are among the four essential outcomes measures:• Customer or patient satisfaction feedback can tell you what’s right and what you can do differently to make your patients feel better cared for. Instead of individual appointments with pro-viders, for instance, working women who undergo breast surgery might prefer borrowing a videotape that conveys what they should expect before and after surgery.
• Clinical outcomes measure your medical results, explains Marjorie M. Godfrey, MS, RN, director of accelerating clinical improvement at the Lahey Hitchcock Clinic of Dartmouth-Hitchcock Medical Center in Lebanon, NH. For example, have low birth weight babies decreased among attendees of a prenatal nutrition class?
• Cost figures should capture both direct and indirect resource outflow. Direct costs include staff salaries and the bills for buying or creating teaching materials. Indirect costs should include costs to everyone involved, even patients, Godfrey notes. She explains with this example: If patients must spend excessive time traveling to your facility for educational programs, in lieu of more efficient means, they might forego the education and incur higher medical costs later.
• Functional status reveals the "real life" results of health education. How soon does a patient go back to work after a hysterectomy? How many of your diet management workshop attendees reach and maintain a healthy body weight?
If your measure tells you something that helps you meet your objectives, it’s a good one. For example, Jean Harry, RN, administrative leader at the Burlington, VT-based Fletcher Allen Health Care Breast Care Center, measured breast biopsy reschedulings and found that they dropped when nurses started routine patient phone consultations a week before surgery. Nurses simply reminded patients to avoid aspirin and ibuprofen (to reduce the danger of excess bleeding) for seven days prior to biopsy.
Godfrey suggests additional practical outcomes measures. In a mastectomy support group, what is the frequency of lymphedema compared with nongroup members? In a breast-feeding group, how many mothers continue nursing for the first six months compared with national averages?
Data collection and analysis use more resources than you might imagine. "If you collect data that will not lead to action, it’s useless," Godfrey cautions. So it’s a good idea to weigh the affordability of your measurement scheme against the projected benefit. (For a guide to outcomes measurement planning, see diagram, "Making Improvements: Clinical Improvement Worksheet," p. 23.)
Here are two vital affordability questions:
• Can your staff incorporate data collection into their existing activities? If the process becomes odious, you could lose key employees’ cooperation and willingness.
• How much extra time and tolerance can you expect from your patients?
One way to lighten the imposition of data collection without compromising quality is randomization, suggests Godfrey.
"You don’t have to measure everyone all the time," she notes. For instance, distributing satisfaction questionnaires to every third or fifth patient will do.
You’ll never outgrow your need for satisfaction surveys. "As providers," Godfrey says, "we think we know what our patients want. But we have to ask them and be willing to listen to their feedback."
Indeed, asking and listening reversed a recent decision to call a holiday break in breast cancer support groups at the Manchester, NH-based Breast Health Center. Breast health specialist Elizabeth Hale-Campoli, RN, OCN, relates that she and her staff thought patients might be too busy for meetings between Thanksgiving and New Year’s. However, a support group poll revealed an acute need to convene during the holidays, and naturally, the groups’ wishes prevailed.
High attendance numbers and glowing feedback could be precisely what you’re looking for if your objectives are like those of Women’s Health Resources at the Illinois Masonic Medical Center in Chicago. The facility aims to serve patients’ needs and educate the community at large, says education coordinator Kristen Full. Topics include panic recovery, postpartum wellness, and weight management beyond dieting. "The best measure of our current objectives,"she says, "is patient feedback and good attendance." With 3,000 women in attendance every month, the program more than meets its objectives. (For more on outcomes measures, see "A Handful of Data Collection Essentials," above left, and Women’s Health Center Manage-ment, May 1997, pp. 60-61.)
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