Big Data
Volume amount of data
Variety range of data types and sources
Velocity speed of data in and out
Value The most important V for healthcare!!
Population Health Management
Value = Outcomes / Cost Triple Aim
• Improving the patient experience of care (including quality and satisfaction)
• Improving the health of populations
• Reducing the per capita cost of health care
Value
Patient Care Adherence Clinician EBM Adherence+
Efficiency+ Mortality
Morbidity+ Evidence Based
Equitable+ Safety+ Effective+
Quality of Life Functionality+
Satisfaction+ Sustainability+
Administrative Cost+ Payer Cost
Timeliness Lost Production+ Out of Pocket Costs+
Time+
Individual Production Societal + Production
Appropriate Care
Clinical Outcomes
Process Measures
Patient Outcomes
Payer
Cost Individual
Cost
Societal Cost
Value
Outcomes
• Process Measures
o “Value based” programs and various regulatory / accreditation programs primarily include process measures
• Outcomes relevant to patients and their families o Mortality
o Quality of Life, including Health Related Quality of Life o Discuss other examples of outcomes that are relevant
to patients and their families
Health Outcome
International Consortium for Health Outcomes Measurement (ICHOM) Outcomes are the results people care about most when seeking
treatment, including functional improvement and the ability to live normal, productive lives.
ICHOM's mission is to unlock the potential of value-based health care by defining global Standard Sets of outcome measures that really matter to patients for the most relevant medical conditions and by driving
adoption and reporting of these measures worldwide.
ICHOM Standard Sets
By 2017, we aim to have published 50 Standard Sets
covering more than 50 percent of the global disease burden.
Patient Reported Outcomes
• National Quality Forum(NQF)
– Definition: Patient-reported outcome (PRO): Any report of the status of a patient’s health condition that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else.
• (U.S. FOOD AND DRUG ADMINISTRATION. Guidance for Industry.Patient-Reported Outcome Measures: Use in Medical Product Development to Support Labeling Claims. Federal Register 2009;74(35):65132-133.)
• Patient Centered Outcomes Research Institute (PCORI)
– Vision : Patients and the public have information they can use to make decisions that reflect their desired health outcomes.
• Patient Reported Outcomes Measurement Information System (PROMIS)
– Measures of patient–reported health status for physical, mental, and social well–being
– Funded by NIH
PROMIS
• Domains
– Physical Health – Anxiety
– Depression – Fatigue
– Sleep Disturbance – Social Function – Pain Interference – Global Health
• Physical Health – Adult (PROMIS Short Form v1.0 – Physical Function 12a)
• Are you able to walk a block on flat ground?
– Without any difficulty – With a little difficulty – With some difficulty – With much difficulty – Unable to do
• Does your health now limit you in doing strenuous activities such as backpacking, skiing, playing tennis, bicycling or jogging?
– Not at all – Very little – Somewhat – Quite a lot – Cannot do
• Are you able to get in and out of bed?
– Without any difficulty – With a little difficulty – With some difficulty – With much difficulty – Unable to do
Source : http://www.nihpromis.org/Measures/SampleQuestions. March 2015
PROMIS
• Domains
– Physical Health – Anxiety
– Depression – Fatigue
– Sleep Disturbance – Social Function
• Adult
• Pediatric
• Parent Proxy – Pain Interference – Global Health
• Social Function Adult (PROMIS Item Bank v2.0 - Ability to Participate in Social Roles and Activities 8a)
• In the past 7 days…
• I have trouble doing all of my regular leisure activities with others
– Never – Rarely – Sometimes – Usually – Always
• I have trouble doing all of my usual work (include work at home)
– Never – Rarely – Sometimes – Usually – Always
• I have to limit my regular activities with friends – Never
– Rarely – Sometimes – Usually – Always
Source : http://www.nihpromis.org/Measures/SampleQuestions. March 2015
Social Determinants of Health
• “Circumstances in which people are born, grow up, live, work and age, as well as the health systems they utilize” (CDC 2013).
• “The best available estimates suggest that the conditions for which patient seek medical care (accounting both for access to care and the quality of care that is received) account for only about 10 percent of early deaths, whereas health behaviors and social conditions are estimated to account for
more than half of such deaths(McGinnis et al., 2002).
• IOM Committee formed to “identify domains and measures that capture the social determinants of health to inform the development of
recommendations for Stage 3 meaningful use of electronic health records (EHRs).”
• Healthy People 2020 – good resource
Source: IOM (Institute of Medicine). 2014. Capturing social and behavioral domains and measures in electronic health records: Phase 2. Washington, DC: The National Academies Press.
Babies Born Just Miles Apart in Las Vegas Face Up to 16- Year Difference in Life Expectancy
Recommendations for inclusion in EHR
Certification and Meaningful Use Regulations
• 4 social and behavioral domains that are already regularly collected – Race/ethnicity
– Tobacco use – Alcohol use
– Residential address
• 8 additional domains
– Educational attainment – Financial resource strain – Stress
– Depression
– Physical activity – Social isolation
– Intimate partner violence (for women of reproductive age) – Neighborhood median-household income
Source: IOM (Institute of Medicine). 2014. Capturing social and behavioral domains and measures in electronic health records: Phase 2. Washington, DC: The National Academies Press.
