1. Outcomes Measurement in Health
Pathfinder Workshop
19 September 2001

2. Outcomes
A change in health status that can be attributed to a particular action or intervention
Focus upon individual outcomes:
Mortality
Morbidity
Focus upon population level outcomes – combined measures
Long history in health (PHOT since 1993)

3. Individual Outcomes - Mortality
Female
Male

4. Cardiovascular Outcomes

5. Asthma Outcomes

6. Individual Outcomes May be attributable
Possible to build into managerial processes
Possibly easier in secondary care
Have ethnic / cultural differences

7. CI 1: 30 day in-hospital perioperative mortality by method of admission (casemix adjusted)
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8. Model of causation Determinants Risk Exposures Diseases & Injuries
Health Outcomes

9. Population level outcomes
Desire to measure outcomes at the whole population level
Life expectancy
Integrated health measures

10. Example: Life expectancy by small area deprivation

11. Life Expectancy at Birth

12. Health Outcomes Quantity of Life – prematurity of mortality
Quality of Life – physical, mental, social
Combined measures – HALE, DALY

13. Combined Measures
DALY – health gap measure – represents the loss of one year of healthy life
HALE – Healthy life expectancy
QUALY – Used in CUA to compare different health states

14. Example: Disease DALYs

15. Example: Risk Factor DALYs

16. Comparing DALYs

17. Lessons learned Outcomes are accepted in health – but has taken time!
Huge effort & databases etc
Much work is now clinically driven
Tied to initiatives such as patient focused care etc
Other initiatives such as clinical governance etc

18. Lessons learned Attributability may be difficult Cultural issues
Issues in population level outcomes
Cross country comparisons are difficult

19. Taking Outcomes Forward
DHBs given accountability to achieve health gain for their populations in 13 areas
Guidance issued by MoH in Toolkits
MoH also looking at outcomes – attribution at a national level
Continuing work with WHO