What health care can learn from sports

A new blog by Steven Lewis, Mark Wahba and Mary Smillie was launched in October, 2011, with the purpose of creating “a community of thinkers, writers and readers interested in exploring how health and medicine can learn from the development, use and application of statistical analyses in sports.”

The authors of “Meaningful Analogies in Sports and Health” (M.A.S.H.) were inspired by the Michael Lewis book, Moneyball (now a major motion picture starring Brad Pitt) – a chronicle of the Oakland A’s manager’s success in building his baseball team on a budget by using data. The blog operates on the premise that health care could be better if data as well as concepts from baseball and other sports were used to improve decision making and overall quality.

Interesting concepts are discussed, and new ways of thinking about evidence-based decision making are presented. Not only are the discussions relevant to those of us in health and health care policy, but are also often of interest to the public. For example, one post discusses performance measurement in figure skating, and shows how a former scoring system overvalued certain metrics, similar to the way certain health care performance measurements are undervalued.  

The best part is that the discussions make meaningful analogies to issues in sports, a topic more widely accessible to the public than the usual health care policy forums.

Susan Brien, Policy Lead, Health Council of Canada

Photos from the Health Council of Canada’s National Symposium on Patient Engagement

On October 25, 2011, the Health Council of Canada hosted an invitational symposium on patient engagement in Toronto, Ontario.

This event brought together patients, health care providers, health system planners, government representatives and researchers from across Canada to explore the challenges and opportunities in patient engagement and the benefits to be gained from involving patients in the design of the Canadian health care system.

Participants gained a better understanding of what is needed to shift system-level design of health care services from ‘provider-focused’ to ‘patient-centred’.

Here are some photos from the event:

Lessons learned from the UK on the quality of patient engagement

2010, The King’s Fund commissioned an inquiry paper by Picker Institute Europe to review the quality of patient engagement and involvement in primary health care. The paper focuses on patients’ engagement in primary consultations about their own health care, namely the interaction between the general practitioner and patient. Similar to our findings in a recent report, the importance of patient engagement is underscored.

In the UK, efforts have been made to bring patient engagement to the forefront. In the last four years, the NHS has reviewed professional codes, legislation and regulation to propose patient engagement as a requirement for all doctors.  Over the past decade, professional education and training for doctors has been revised to highlight communication skills.

Although these changes have resulted in some improvements, the report cites remaining challenges in patient engagement. There are certainly parallels to challenges identified in our previous work, as well as others for future consideration.

                     

Some key challenges highlighted in the report are:

·        Workforce skills: There is a need to train professionals in advanced communication skills that aid in understanding patient values, preferences and desire for involvement in decision making. Although developing patient-partnership skills has become a focus for professionals trained during the last decade, these individuals are less likely to be in senior roles in the health care system and are less likely to be influencing a practice model that encourages patient partnerships. 

·        Practice orientation: There is little awareness of the value for practices to adopt a patient-partnership approach, particularly since there are no specific financial incentives or outcome measures tied to engaging patients.  

·        Health Literacy: The ability of patients to read, understand and make use of health information available to them in their decision-making can be a barrier to engagement. The strong relationship between health literacy and health inequalities suggest that to improve patient knowledge information must be designed to adjust to patients’ health literacy levels.

·        Time factor: The length of consultation time available is a key barrier to engagement for both physicians and patients.

The complete report is available here.

Commonwealth Fund findings on "sicker" adults released

The annual Commonwealth Fund International Health Policy surveys track trends in health care access, affordability, quality and general policy and practices issues internationally.

This week,  the Commonwealth Fund released its findings from the 2011 survey with a focus on the United States’ health care system. The 2011 survey looked at health care experiences of adults who are likely to have greater health care needs (so-called “sicker” adults).

The Health Council of Canada, a co-founder of this survey, has used the same data to understand Canadian health care system performance from the views of ‘sicker’ adults in the 11 participating countries. In our analysis, sicker Canadians are those with chronic conditions who describe their health as poor or fair. Our analysis highlights the gaps in our health care system for this population of sicker Canadians who have greater health care needs in access, affordability, timeliness, coordination and patient engagement.

Access

• Of the countries surveyed, Canadians (36%) rank high in finding it very difficult to access care in the evenings, weekends and holidays, without going to an emergency department.
• Canadians (60%) are the most likely to use the emergency department when compared internationally (47%). As a result Canadians are also among the highest users of emergency departments for conditions that could be treated at their regular place of care if it had been available.

Affordability

• Canadians rank second highest (following the US) in reporting concerns about prescription costs. Nearly one-quarter of sicker Canadians report not filling a prescription for medicine, or skipping doses because of cost.

Timeliness

• Overall, Canadians have the longest waits to get an appointment. Only half of Canadians (50%) say can get an appointment on the same or next day when they’re sick or need medical attention. Canadians also have long waits to see a specialist compared to international respondents. Half of Canadians (50%) say they have had to wait four or more weeks to see a specialist after being advised to do so.

Coordination

·         Canadians have the most difficulty in having their test results or medical records available at appointments. Nearly one-quarter say their test results or medical records were not available at the time of their appointment.  However, Canadians rank above international average in receiving help from their regular doctor to coordinate other care.

Patient engagement

·         Sicker Canadians (55%) are among the those least likely to report they have enough time with their doctor, a key barrier to patient engagement. However, these same Canadians have similar ratings to the international average in understanding information from their regular doctor and feeling encouraged to ask questions. 

For more detailed findings on these key areas of health system performance, please download our findings chart pack with a comparison of sicker Canadians internationally.

In December, we will release a report that focuses on the health care experiences of sicker Canadians’ compared to that of the general public. The report highlights what is working and isn’t working in Canada as it pertains to Canadians with greater health care needs.

Sukirtha Tharmalingam, Senior Policy Analyst, Health Council of Canada

Key Words: Access and Wait Times, Primary Health Care