The Importance of Positive Approaches to Assessing Healthcare

Measuring Outcomes, Assessment and Research

When it comes to evaluating the effectiveness, efficiency, performance, efficacy and quality of a healthcare outcome, there are important components to focus on. There are several levels of "value," including business value, the value of an employee (whether it be a nurse, orderly, doctor, and other medical specialists), the value attached to the ability to learn new procedures and technologies in the healthcare field, and certainly the value of the customer.

Assessment and Measuring Tools vis-a-vis Healthcare Outcomes

However, there are other considerations to take into account when performing tasks related to evaluation (effectiveness, performance, et. al.). For example, in the Journal of Advanced Nursing the authors present data from the National Prevalence Measurement of Care Problems (LPZ is the acronym in Dutch), which is a study that looks into the " ... prevalence, prevention, treatment and quality indicators" of six basic care issues (Halfens, et al., 2013). Although the results have universal applications, this peer-reviewed research was conducted in Austria, the Netherlands and Switzerland; and the six basic care issues are incontinence, malnutrition, ulcers, intertrigo (a skin disorder), falls and restraints (Halfens, e6). The data used in the LPZ is based on an annual comprehensive, standardized questionnaire taken at the patient level, the institutional level and by department.

The results of the LPZ research shows that the prevalence of "pressure ulcers" in Holland is higher in hospitals and lower in nursing homes in comparison with rates of prevalence in Austria and Switzerland (Halfens, e14). Also, incontinence shows up more often in Austrian hospitals and nursing homes than in Holland and Switzerland. These studies indicate the differences in how "care problems" are addressed in different cultures, and they could become benchmarks in the implementation of international guidelines (Halfens, e16).

Meanwhile, a scholarly paper in Clinical Chemistry & Laboratory Medicine offers insights into how best to reduce errors when it comes to assessing the quality of methods used in laboratory studies. The reason this is important is that typically the assessment testing of lab results -- in-vitro diagnostics (IVD) -- has been " ... fraught with uncertainty" in spite of the ambitious work of lab technicians to minimize uncertainty (Topic, 2015). And while the methods used to assess and measure healthcare lab results are generally validated ahead of time by diagnostic companies, end-users must verify the methods "independently" -- especially when performance in labs has "worsened with time" (Topic, 1710). The best solution in terms accurate laboratory results is to focus on ensuring that "... blood collection systems fulfill specific requisites of quality, workability and efficiency" (Topic, 1716).

The Milbank Quarterly (Journal of Population Health and Health Policy) published research -- drawing data from three countries, England, the United States, and The Netherlands -- showing that patient-reported outcomes (PRO) can be used for more than improving patient-centered healthcare. In fact when PRO-is used in a way that involves a " ... shared vision of clinical professionals, purchasers, and patients," PRO-measures help "assess and compare the quality of healthcare providers" (Van der Wees, et al., 2014). How did the authors identify key healthcare experts in these three countries?

They went to organizations in the healthcare field that are known to use PROs in clinical practice. They also went to organizations in these three countries that were already assessing the strength, reliability and relevance of PROs. They then emailed experts from 42 organizations " ... stratified by care setting and country," and got approval for their research through the RAND Human Subjects Protection Committee (Van der Wees, 758).

The quality and care used when collecting data -- after interviews were conducted and later transcribed "verbatim" into the software program (Atlas.ti) -- relates to how well structured the interview process was designed. Van der Wees explains (757) the three key policy questions regarding patient outcomes -- posed to "selected experts working in clinical practice, quality measure development, and quality reporting programs" in the three countries -- are as follows:

One: What approaches are embraced when PRO-measures are part of performance measurements and clinical practices? Two: What are the " ... facilitators of and barriers to the further implementation of PRO-measures" both in performance measurement and clinical practice? And three: Is it possible to "integrate PRO-data collection for use in clinical practice and performance measurement? (Van der Wees, 757-758). Since the use of patient-reported outcomes is the foundation of this research -- as researchers attempt to use PROs as a measure for assessment and evaluation -- the health experts being interviewed needed a clear definition of PRO. "Any report of the status of a patient's health condition, health behavior, or experience with healthcare," which is delivered directly by the patient, is a PRO (Van der Wees, 758).

A corollary needs to be attached to that definition, and it is that the report from the patient cannot be interpreted, or editorialized, or changed in any way by the clinician or anyone else involved in the collection of this data, Van der Wees explains.