"Give a darn" outcomes

A few years ago, I asked whether hospitals should be run like hotels.  I mentioned a study by Dana Goldman and John Romley at the RAND corporation that was published by the National Bureau of Economic Research (NBER) in 2008 entitled "Hospitals as Hotels: The Role of Patient Amenities in Hospital Demand".  The two investigators also later published an editorial piece about their study in the New England Journal of Medicine.  The study involved almost 9,000 Medicare patients (so that hospital price was not a factor in the choice of hospital) who presented to one of 117 hospitals in the Los Angeles, California market for treatment of pneumonia.  Hospitals were assessed and ranked from both a quality of care perspective (using mortality in patients with community-acquired pneumonia) and a patient experience perspective (based on "good food, attentive staff, and pleasant surroundings").  Patients under 65 years of age were excluded.  When the patient experience ranking improved by one standard deviation, the demand for that hospital increased by close to 40%.  Conversely, when the quality of care ranking improved by one standard deviation, hospital demand increased by only by 12%.  I also mentioned a systematic review published in the Journal of Healthcare Management which found that patients were more likely to return to the same hospital or ambulatory clinic if they had a positive experience.

It is with that post in mind that I read a recent commentary published in NEJM Catalyst ("Outcomes or experiences - what do patients value more in evaluating medical teams?").  The investigators in this study surveyed 998 patients from four European countries (France, Italy, Spain, and the United Kingdom) with diagnoses of breast cancer, diabetes, inflammatory bowel disease, depression, or arthritis and asked them to rate the importance of so-called patient-reported outcome measures (PROMs) versus patient-reported experience measures (PREMs).  PROMs generally measure the quality of care based upon what outcomes are most important to patients, e.g. the patient's self-determined health-related quality of life.  Although patients considered both outcomes important, on average 83% of patients considered PROMs to be more important than PREMs for choosing a medical team.  

Importantly, organizations are starting to catch on that the outcomes that matter most to patients and clinicians may differ from what may be important to regulatory agencies.  As one recent example, Newsweek magazine and Statista have started to use PROMs in their annual review of the World's Best Hospitals and World's Best Children's Hospitals.  At my own organization, we are starting to focus on "Outcomes That Matter" - those outcomes that are of most importance to our patients and families.  Similarly, Providence St. Joseph Health focuses on "give a darn" measures.  All outcome measures are required to pass the "give a darn" test.  As Dr. Amy Compton-Phillips, Executive Vice President and Chief Clinical Officer told Dr. Thomas Lee in an interview for NEJM Catalyst (see "The “Give a Darn” Method for Outcomes Measurement"), "We use something called the ‘give a darn’ test. What are the outcomes that your colleagues would care about if they were better than their neighbor? And what are the outcomes that your patients would care about if you were better than your neighbor? If a measure is in both those sets, then that’s an outcome that matters."