Publish or perish the outcomes game

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Publish or perish the outcomes game

• Andrew Vallance-Owen, Group Medical Director

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BUPA

• Founded 1947
• To prevent, relieve and cure sickness
• and ill health of every kind and promote health
  in any way

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BUPA - Overview

• A broadly-based international health and care
  group
• Private medical insurance
• Occupational health
• Care homes
• Hospitals
• Clinics
• Health assessment/wellbeing centres
• No shareholders profits re-invested in business
  
• 8.1m customers in 190 countries
• Aspiration to help our customers live longer,
  healthier, happier lives

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Outcomes what are they?

• A means of seeing how well were doing
• A means of comparing ourselves against others
• A means of making sure were safe
• A means of patients telling us if were doing the
  right thing
• A means of informing patients and facilitating
  informed choice

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Performance Indicators

• Deaths/survival rates
• Unexpected re-admissions
• Unexpected re-operations
• Infection rates
• Adverse incidents
• Clinical complaints

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Individuals capacity to exercise choice will
depend on 3 factors understanding choice, and
having confidence and opportunity to choose
People need to be able to understand choice in
order to exercise it effectively
Understanding
Understanding alone is insufficient, however.
People also need confidence to exercise choice
Confidence
And people need the opportunity to exercise
choice
Opportunity
Without each of these elements, the consumer
cannot successfully exercise choice
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The involvement of Healthcare professionals
The right information delivered through the right
channels, in the right format
Raised awareness of choice
Understanding
Confidence
Opportunity
Will support individuals understanding and
confidence and will ensure (s)he has the chance
to exercise meaningful choice
Will increase anindividualsunderstanding of
and confidence to exercise choice
Will increase understanding
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Patient-Reported Outcome

• An additional insight, independent of data
  collection on the ward, or by the consultant
• Shifts emphasis from failure to health gain
• SF-36 the nearest thing to gold standard
• Rigorous development
• Validated worldwide
• Huge research literature
• Generic tools vs condition-specific eg VF-14

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Outcome tools SF-36, VF-14, Oxford

• We have used SF-36 since 1998 to monitor, for
  example
• Inguinal hernia
• Laparoscopic cholecystectomy
• Hysterectomy
• Septoplasty
• TURP
• Augmentation mammoplasty
• VF-14 used to monitor cataract surgery since 2002
• Oxford scores now used to measure hip knee
  replacemtents

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Process

• Patients are identified when admission is booked
• SF-36 or VF-14 form sent with to come in letter
• Baseline forms collected by hospital, sent to
  bureau
• Bureau sends postal questionnaire 12 weeks later
  (16 weeks for VF-14)
• Quarterly reporting to hospitals, annually to
  consultants
• Patient ID not revealed to consultant or hospital
• Bureau Outcome Technologies Ltd (BUPA
  subsidiary)

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A typical hospital report (hysterectomy)
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Internal monitoring of performance
Sentinel procedure outcomes, against internal
quarterly target
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The challenge of how to explain complex
statistics in very simple terms
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Listen to our consumers
Give consumers real information for choice
Help to develop new tools appropriate to specialty
Involve health professionals in outcomes
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Outcome Technologies Ltd

• Wide range of tools such as SF36, VF14, Oxford
  Hip and Knee Scores etc.
• Consultancy service to identify appropriate
  outcome tools
• Largest SF-36 database in Europe
• Scaleable and cost effective capture of outcomes
• Ability to use wide selection of media Paper,
  Email, Phone, Text, Fax, PC etc.
• Contact  c.minnett_at_outcometechnologies.com
• 44 (0)207 656 2460

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Any Questions?