Measurement – End Results More Important Than Questions
cause is hidden, but the result is well-known.
(43BC – 19AD), Metamorphoses
There is rarely anything new under the sun.
No matter how you slice it or how you compose
questions for a health questionnaire,
people tend to fudge, exaggerate, or downplay their habits and personal
behavior that got them to where they are – overweight, obese, hypertensive, diabetic, or with adverse lab
values – high glucose, high hemoglobin
A1C, or troublesome cholesterol, LDL, HDL, and triglyceride values. It is human nature to make one’s self look
good, or less bad.
That being so,
it is simpler, and there is value
and truth in measuring the body’s end
results – BP, pulse, height, weight, waist size – and chemistry results, rather than exploring one’s eating, drinking,
and exercise habits.
In other words, keep it simple , measure the unfudgeable, and state the results in terms the patient
For these purposes, I advocate an overall health
quotient (HQ – normal range 80-120) with an explanation of why the patient’s HQ
is normal, low, or high.
See Medinnovation blog, April 20. 2013, “An
Innovative Proposal: Routine Health
Measurements in Primary Care Practices and in Wellness Programs"
Or read the following from Kaiser Health News to see how complicated and difficult measures of
health can be.
Foden-Vencil, Oregon Public Broadcasting
Oregon’s Dilemma: How To Measure Health?
Apr 26, 2013
There are hundreds, if not thousands, of ways to track
the health of a population: the average blood pressure of a large group of
people, the rate of mental illness, the average weight. Epidemiologists have
been collecting this kind of data for years, but now, in Oregon, there is cold,
hard cash riding on these metrics
In a special experiment that is part of the health law, the
Obama Administration gave Oregon almost $2 billion to come up
with its own system to coordinate care better. The idea is to get doctors,
nurses, hospitals and other caregivers to work together – and get paid well --
to keep people healthy and to get rid of wasteful, unnecessary care.
But which metrics should Oregon and the federal
government look at to decide if the experiment succeeds? The federal dollars
will go to the providers who do a good job, so first the state had to figure
out what constitutes good coordinated care.
Sarah Bartelmann of the Oregon Health Authority’s Metrics
and Scoring Committee says it was hard to boil down the list. There
was "a lot of discussion and the conflict was where the data would come
from and if it was something the state could easily report on," she says.
Oregon decided on 33 measurements that cross the medical
A look at one of them shows how quickly it can get
complicated. Bartelmann explains the effort to measure how often doctors ask
patients if they're abusing drugs or alcohol.
"So there are a couple of ways a practice could do
this,” she says. “They could start with a pre-screen, that would be just one
question that a doctor would ask. It could be part of your vital stats, when
they're taking your blood pressure, weighing you in. They could also ask, ‘Do
you use alcohol? Do you use drugs?’ And if the patient indicated that they did,
to either one of those, that would then trigger a longer screening."
The goal is to get doctors to refer patients to a service
-- patients don't actually have to go to be counted, but they have to be
referred. But it's a measure that Oregon has created on its own, so there was
no national standard.
To figure out where to start, Oregon Health and Science
University studied how often doctors currently ask patients about drug or
alcohol abuse -- not just whether they smoke or drink, but specifically about abuse
of those substances. The answer was virtually never.
"This is a difficult subject for doctors to talk
about with patients," says Lori Coyner of the Oregon Health Authority.
So, since doctors aren't asking the question now, the
baseline was set at zero. The state then had to decide where to set the goal.
The university looked at one group of local doctors who
started asking about substance abuse and found that after a couple of years, 44
percent had managed to set up a system to do it on a regular basis. So that’s
where Oregon's Metrics and Scoring Committee set its goal.
"The committee wrestled with setting a benchmark
that seemed so high, 44 percent compared to approximately zero percent right
now,” says Bartelmann, “and whether that was truly achievable by CCOs."
Not everyone is happy with the new measurement.
Rick Hangartner, who runs an electronic health records
company, thinks it doesn't go far enough to help people battling drugs or
"The big problem is finding a treatment program that
can actually take them that works for them,” Hangartner says. “If the whole
point is improving health, which is what the claim is about [coordinated care
organizations], we've got to show some follow through."
The state is wrestling with questions like this for all
33 of its chosen metrics.
On top of that, Oregon has to worry about timing. For
instance, rehab for drug abuse or alcoholism could save the state a lot of
money in the long-run by preventing dire diseases. But in the short-term, rehab
Tweet: The end results of how much one exercises,
eats, drinks, or uses drugs is usually reflected in one's vital signs and chemistry