Health ministers from the world’s major industrial powers gave their backing to a new international patient outcomes league table at a meeting in Paris on January 17th.
The patient reported indicator survey (PARIS), in development by the OECD, will collect a new generation of health statistics on patients’ own experience of medical care and health care outcomes.
“It will involve the actual rolling out of a set of commonly accepted indicators to track quality, access and value for money of health policies and inputs,” said OECD secretary-general José Ángel Gurría. “We will no longer just measure health inputs, but also whether medical care leads to people being in less pain, more mobile and in better health.”
The data collection will start small, covering representative samples of patients who have had strokes, heart attacks, cancer, hip and knee surgery, and mental illness. The Commonwealth Fund and the International Consortium for Health Outcomes Measurement (ICHOM) will help design survey questions and indicators.
“We want to hear patients’ experiences,” said Francesca Colombo, head of health at the OECD, noting that her group already records some aspects of patient experience in 19 countries. “What is their pain like? How is their functionality? Can they live a normal life now? These kinds of questions.”
Knowing more about patient experiences is essential for lowering the cost of healthcare, said influential Harvard economist Michael Porter, who co-founded ICHOM in 2012 to promote value-based healthcare by defining outcome measurements that are clinically relevant and really matter to patients.
“We measure a lot of stuff [but] we have to measure the most important thing. Outcomes are the things patients want to know the most about. When we think about cost reduction, we need outcomes,” Porter told the meeting.
The OECD thinks the surveys could eventually grow to be on a par with PISA (Programme for International Student Assessment), a test comparing the educational attainment of 15-year olds.
When OECD first set out to establish PISA, it faced the same arguments as there are currently over patient-centric outcomes – that school systems are so variable it is impossible to develop comparable international metrics.
However, there are now 65 countries participating in the test, the results of which dominate analyses of the quality of different national education systems and are used to inform policies and drive change.
Pisa gathers data on science, maths and reading skills every three years but the frequency of new patient outcomes assessments has yet to be decided.
“A ministerial mandate is a big thing but the nitty gritty of the plan is obviously going to be more difficult,” said Colombo. “We need to get a lot of people on board at all levels. First, we need a proof-of-concept to reassure all stakeholders that this can work,” she said.
The Canadian health minister, Jane Philpott, believes it can. “Let’s get this done,” she said. “Enough academic papers have been written on the topic already.”
An increasing number of drug overdoses and the rising rate of suicides in Canada’s aboriginal peoples have convinced her of the need to create, “a more patient-centred health system”, Philpott said.
The patient outcome surveys, “Don’t necessarily need to be perfect the first time around”, Philpott added, acknowledging that it could take two or three years to amass good enough data for all the countries that participate.
Norwegian health minister, Bent Høie, said the new measurements will be a very important policy tool. “My most important role is to involve patients in all decisions related to their care. The patient is the real expert in his or her real life. They have to meet with health provider experts at the same level,” said Høie.
Not every country is likely to be so enthusiastic, however. “There are always those afraid of being ranked,” said Colombo.
Although like every survey, it has some shortcomings, PISA reveals stark truths about the relative performance of education systems. The new patient outcomes survey could similarly shame countries into action.
Xavier Prats Monné, director-general of the European Commission’s directorate for health and food safety, acknowledges the difficulty of using a standardised test to compare countries of vastly different sizes, but said policymakers should welcome the challenge.
“Yes, the methodology is complex – it’s not going to be an easy task, let’s be under no illusion – but this should not discourage us. We have the opportunity of reproducing in health what we did in education,” he said. “Pisa is not perfect but it compelled policymakers to do better.”
The EU already works with the OECD on research into European health systems and will support the development of the outcomes league table, both politically and financially, Prats Monné said.
OECD health statistics have driven policy change in the past. For example, South Korea put a huge amount of effort into improvements after it saw its lowly ranking against other OECD members in 30-day mortality after admission to hospital for a heart attack.
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