Chapter 2: An Outcome Approach to Patient Care Management

INTRODUCTION

An outcome perspective in patient care influences the clinician’s approach to patient examination, the organization of documentation, and the expected service outcomes. This chapter introduces a definition of outcomes and relates that definition to patient care management. It describes strategies to use with patients to facilitate an outcome approach to care. Two traditional approaches to patient care are contrasted with an outcome approach. These patient care approaches are related to documentation design. Integration of an outcome approach will help the clinician identify goals that are meaningful to patients and support more efficient paths of intervention to achieve those outcomes.

DEFINING OUTCOMES

The American Heritage Dictionary (1981) defines outcome as a “natural result or consequence.” Tabor’s Cyclopedic Medical Dictionary (2005) defines a positive outcome as “the remediation of functional limitation or disability; the prevention of illness or injury; or an improvement in patient satisfaction.” This textbook suggests a broader definition of outcomes.

In this book, health-care outcomes refer to those categories of measurement or observation that service providers attempt to improve. The observations can be of patients, providers, processes, or entire health-care systems. A single outcome may have a range of results within it. For example, “return to work” is a common patient outcome, with results ranging from “no return to work” to “complete recovery of prior work status.” Patient goals are set individually to achieve a selected level of result within a type of outcome. Likewise, administrative goals are selected to achieve a level of result unique to a setting within a category of outcome. Two examples of administrative outcomes are the cost of service and the level of patient satisfaction.

Outcome measures refer to tools or procedures used to quantify progress toward an expected outcome. These tools may be published evaluations that produce a score or measurement strategies that are reproducible across clinicians, patients, or administrators. Examples of measurement tools include the Barthel Index and the SF-36; examples of measurement strategies include the Timed-Up-and-Go and the calculation of gait velocity.

Ideally, in patient care, a meaningful result is one that has relevance to at least two people or parties: the patient receiving the service and the service provider. Although it is possible to argue that an outcome can be meaningful to just one party, strategies for achieving outcomes are enhanced by mutual cooperation. In addition to the patient and the provider, other parties may have an interest in the results. These parties include family members, referral sources, ...