Information about patient reported quality
(Sports analogy-ok to skip)
We’re familiar with simple numbers reporting results in sports, even though the process that produces that score is complicated. We can report the results for the $10 million US Open with one number for each player.
We could be comparing the number of yards on each drive, the number of landings in the rough, the number of putts on each green, the percent of putts made from within 10 feet, plus all sorts of other minutiae, but they’re too complicated, and not as useful as a single number.
We can summarize any player’s ability with their score for 18 holes on a full sized course. A typical weekend golfer will score ~105, a serious golfer around 90, and a pro around 72.
And even in professional tournaments, it’s really easy to record- their partner writes the number of strokes for each hole on a card using a stubby little pencil, and they add it up. Millions of dollars ride on the score, but they don’t need a more complicated system.
Primary Care doesn’t either.
The bottom line:
John Wasson at Dartmouth created a patient feedback tool that tells practices how they’re doing, and gives them actionable feedback. It assesses patients’ confidence in how well they can manage their health problems, and how well the practice meets their needs. His team has validated and tested the tool (How’sYourHealth or HYH) for about 30 years.
It’s simple for the patient-they answer a series of questions online. It’s simple for the practice- they get back summary numbers, plus feedback on patients grouped by particular diagnoses, age, SES, etc. (A Registry-created automatically!!)
It’s reproducible and robust. Doing well on it requires listening to patients, taking their needs into account, and making an emotional connection that helps motivate people to take care of themselves-all pillars of primary care, and all shown to make a real difference in patient outcomes. It’s Evidence-Based!!
It gives the practice actionable feedback, and points out areas needing improvement, but otherwise doesn’t make delivering superb primary care easy-it just ensures that gathering data doesn’t get in the way of giving good care.
How’sYourHealth is free for small practices (they do ask for donations) and there’s a small charge for practices with more than 3000 questionnaires/year. The ‘Overall Measure’ is robust enough that it can reliably distinguish between big, impersonal practices and small, person-oriented practices- (that overall have lower costs and better outcomes.)
We use How’sYourHealth to compare your practice with a national baseline and assign PCMH levels based on your scores. The number of Standard Deviations above the baseline corresponds to the PCMH level. Person-centered primary care practices should have no trouble documenting they’re providing excellent care.