1. 1 Why Focus on Health Outcomes? a change in direction a forty one billion dollar question Inputs - resources needed to carry out a process or provide a service Outputs – the direct result of the interaction of inputs and processes in the system; the types and quantities of goods and services produced by a service.

2. 2 The Measurement of Output and Productivity in the Health Care Sector in Canada: An Overview (Sharpe, Bradley and Messinger) Conclusions: Price indices for health care output may be overestimated Better documentation of methodologies Quality improvements are not captured Not clear whether increased spending on health is due to higher prices or increasing quality and quantity

3. 3 What are Health Outcomes? A measure of the effectiveness of our health care system and of the impact of public policies that influence health The effect on health status from performance (or non-performance) of one or more processes or activities carried out by healthcare providers. USAID health and workforce improvement project Health outcomes are used to examine the rate of death or illness (eg, the number of lung cancer deaths per 100,000 people). North Dakota health indicator glossary A health outcome is: A change in the health of an individual, or a group of people or a population that is wholly or partially attributable to a health intervention or a series of interventions. Australian government website

4. 4 Choose outcomes that count WHO estimates 1/3 of all social and economic costs to society are due to chronic diseases caused by tobacco, alcohol, high BP, high Cholesterol ad obesity 30% of Canadian have at least one of seven high impact chronic health conditions and 1/3 of these people have multiple chronic health conditions

5. 5 Health Outcomes – the players Public Policy Makers Health Care System Managers Health Care Providers Individuals, families and communities

6. 6 Why Focus on Diabetes or Obesity?

7. 7

8. 8 How do we provide care now? Canadians with diabetes: < 50% get all the recommended tests and procedures that experts recommend > 50% have poor cardiovascular health ~ 50% do not achieve recommended levels of blood sugar

9. 9 We know the problem

10. 10 Collaborative care makes a difference

11. 11 Effective health records Australia Canada Germany Netherlands NZ UK US

12. 12 Quality Care makes a difference *Quality – receives recommended tests and Rx over 5 yrs

13. 13 How can we do it better? Move from find it, fix it to prevent it, find it, manage it

14. 14 Approaches to improving quality of care include effectively measuring outcomes Teams: Interprofessional teams and case management improve quality of care Technology: Electronic health records, reminder and clinical-support information systems can improve quality of care and outcomes Tools: Training and support to set and monitor goals improves quality of care

15. 15 Conclusions Health care (not medical care) requires inter-sectoral cooperation as much as inter-provincial cooperation Health care is a major contributor to the health of the economy and healthy communities are more viable Health care with good outcomes is a contributor to society not a cost We must have appropriate information systems to support health outcome assessment (Visa) Concentrate on a few outcomes with the greatest impact We need specific assessment of individuals within communities over time

16. 16 Thank You www.healthcouncilcanada.ca

17. 17 OECD Health Status Ranking Health Status United States US Rank in OECD CanadaTop Ranked Infant mortality 6.8/1000 live births 265.3/1000 live births Iceland 2.7/1000 Maternal mortality 9.9/10 5 births 224.4/10 5 births Switzerland 1.4/ 10 5 Life expectancy from 65 yrs 19.8 yr 16.8 yr 10 9 20.6 yr 17.1 yr Japan (23) Iceland (18) Adapted from We Can do Better – Improving the Health of the American People. Steven A Shroeder. Shattuck Lecture, N Engl J Med 357;12 September 20, 2007

18. 18 Number of US Deaths from Behavioral Causes, 2000 (Mokdad et al) We Can do Better – Improving the Health of the American People. Steven A Shroeder. Shattuck Lecture, N Engl J Med 357;12 September 20, 2007

19. 19 Health Outcomes – Health Council of Canada The Players Outcomes that can be affected: Public Policy MakersBuild healthy public policy Create supportive and healthy environments Health Care System ManagersReorient health care services to support health and prevent disease Strengthen communities to promote health Health Care ProvidersAccess to needed care Care that is coordinated, integrated and comprehensive Individuals, families and communities The public is engaged in their health care and patients are empowered

20. 20  Change the way we organize and deliver health care for people with chronic conditions  Provide better care for high-risk populations  Coordinate sustained action on prevention