Wednesday, July 27, 2011

On indicators for outpatient health services

Currently it would seem that our health services usually wait for patients to seek services. Only in some circumstances do those services seek patients proactively that might benefit from services. One might ask the question of how the resources available for primary health services could best be allocated to improve health.

It is generally accepted that the most cost effective health interventions are preventive, such as immunizations and certain kinds of health education.

I did a part of my doctoral dissertation on risk indicators, and it seems reasonable to give more care to people at higher risk of needing health services.

Disability Adjusted Life Years (DALYs) have been used for a number of years to account for health benefits. Prior to the use of DALYs, emphasis was on mortality and life expectancy. The WHO initiative to improve outcome measures recognized that disability was also a negative outcome for the health system, and correspondingly, years of disabled life should not be equally credited with years of normal life.

Perhaps one could develop measures of the likely risk of individuals, the likelihood and amount that risk could be reduced by prompt provision of health services, the magnitude of the health risks and health benefits, athe cost of the intervention, and the costs averted for future services that would have been needed without prompt intervention.

I suspect that a good intermediate approach would be to develop risk indicators for a number of common problems and then have clinicians define protocols for those whose risk was sufficiently high. The protocols would include the possibility of contacting the patient and calling them in to receive an intervention.

No comments: