Patient-clinician teamwork facilitates performance measure success

When patients and providers work together on performance goals, everyone can win. A report published online Nov. 3 in the Journal of the American College of Cardiology recommended patients and clinicians share accountability for performance measures to ultimately bring about the best outcomes.

“The goal of performance measurement is to improve patient outcomes, including improving the patient’s health status, and reducing their morbidity and mortality,” said Eric D. Peterson, MD, MPH, from Duke University School of Medicine in Durham, N.C., in a press release. “Therefore, it is important to engage everyone that can have an impact on these goals including patients, family members or caregivers, clinicians, and the healthcare system.” Peterson was co-chair and lead author on the report.

The joint professional task force that included the American College of Cardiology, the American Heart Association, the American Association for Cardiovascular and Pulmonary Rehabilitation, the American Nurses Association and other professional organizations, developed the report.

Peterson and colleagues outlined how performance measures that include patients as well as physicians could be used to improve outcomes as well the challenges to and feasibility of using this method. The report also explored challenges and current examples of shared responsibility performance measures.

Since patient behavior over the long term has inherent effects on outcomes, the task force recommended exploring longitudinal timelines and intermediate patient outcome metrics. Patient factors should be taken into consideration as well, they advised, such as personal preferences, socioeconomic status, health literacy level, social support, cultural or religious barriers to certain treatments and behavioral or psychological factors such as substance abuse or depression. Any of these and other factors could affect the success or failure of performance measures on the individual patient level and should be carefully considered and addressed to better manage adherence in patients when developing a plan.

Patient nonadherence or declining treatment can be valuable learning tools for clinicians to determine areas of improvement, they noted, and should be assessed as part of performance measures aimed at including patients.

They suggested providing patients with specific performance measures to ensure patient engagement.

They wrote that shared accountability should include shared performance results, although the team cautioned that monitoring how such communications occurred was important to avoid damaging patient-provider interactions or creating barriers to care.

Peterson et al noted that shared accountability needs to acknowledge the interdependent qualities of performance measures in order to best achieve positive outcomes. “The goals of patient-based performance measurement should be to enhance patient and family engagement and achieve better outcomes and care experience,” they wrote. Peterson et al recommended that the principles of shared accountability be part of the process in creating, assessing and reporting future performance measures.