To level the playing field at least somewhat, the NIH "wanted to develop a standard way of asking about pain, depression, physical and social functioning and fatigue that could be used in all NIH sponsored clinical trials," Keller says.
Cheryl Damberg, Rand senior researcher and quality measurement specialist in Santa Monica, acknowledges that the pace has quickened to make these functional outcome assessments ready for prime time.
"Five or six years ago, you would barely hear people mention it," she says. "But I think with the work going on at the level of the Office of National Coordinator and meaningful use, and various value-based purchasing measures, people are very focused on outcomes measures now. And providers themselves are saying 'that's the stuff we should be tracking.' "
In the meantime, Damberg says, people are really working hard at an operational level to build tools that ask the right questions" building a tool that takes us beyond patient perceptions of their care, and HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems).
Please don't get me wrong. I think the HCAHPS are important. We want to know that when a patient pressed the call button, help came quickly. It's right that these answers account for 30% of the score to determine a provider's value-based purchasing incentive payment.
But we all know these so-called "hospitality" questions don't really tell us whether the patient got the right tests and diagnosis, the right medications and wound care, the right treatments and follow-up that optimized his or her chance of being healthier after their stay than before. We don't really know if the care that providers delivered actually worked for the patient after they were discharged. We just know that the service was great, or it wasn't.
We need reassurance that providers aren't just going through the motions, but are actually improving quality. Let's hope that functional outcome scoring tools are developed, tested and implemented in a way that answers these questions in a way that hastens improvement of care.