07 October 2016

Standards will improve care for patients whose care is high cost


Iain Carpenter

Standards will improve care for patients whose care costs are high

We are all aware (we cannot forget!) the challenges facing health and social care, not just in the UK, but around the world. Increasing costs associated with better investigations and treatment, greater prevalence of chronic conditions, higher public expectations and an aging population which has impact on all sorts of things like workforce.

People in health and social care are talking about getting electronic health records in place as a means to help deliver care more efficiently. The vision is to integrate
care across hospital, primary, community and long term residential care, supported by information systems that allow real time access to information that is essential to providing good care, particularly for people who use health and care services frequently. In fact, making better use of information by harnessing technology to support it effectively is a potential big winner.

The whole 'raison d'être' of the PRSB is to create and support implementation of information standards that will enable information systems to speak to one another (interoperability) so that the people receiving and delivering care have access to the right information whenever and wherever they need it. To achieve this, we need
to ensure the technology works for us rather than us working for the technology. But equally clinicians and professionals need to change the way we work to make best use of the information systems that support good care.

An articulate presentation of how to address the challenges of high care costs that includes an important IT component was that given by David Blumenthal in his excellent lecture to the Institute of Global Health Innovation. He focussed on where the highest costs are and how to address the challenge in an effective manner.

The 'sickest' 3% of the population account for 45% of the costs of care. The average cost of health and social care across the adult population (231.7 million in the US) is $4,845 per person. The cost for people with three or more chronic conditions (79 million) is $7,526 per person, for those with chronic conditions and one or more limitations in functional ability (11.8 million) the cost is $21,021 per person. The focus for delivering the best return on investment in care then should include:

Targetting interventions towards those most likely to benefit

Close coordination among care team members

Strong health IT

Promoting patient and care giver engagement

Dr Blumenthal rightly identifies strong information sharing systems as a key enabler for improving the quality and efficiency of care for all patients but particularly the 'sickest' patients who use services most frequently. That is why the work of the PRSB is so critical to the future sustainability of our health and care services.

Another area for us to focus on in the UK is not just the health markers of chronic conditions, but also functional impairments. The OECD addresses efficiency and quality, and in relation to long term health care in a report on Monitoring and Improving Quality in Long-Term Care. One chapter examines the role of assessment of physical and psycho-social function, giving a brief history and the example of the interRAI system which is now in place in many countries around the world.

As we move forward in this country, we need to address not only the challenges of getting information to flow across our health and social care providers, but we also need to examine what that information needs to include if we are to make progress in one of the most challenging areas of our society, doing the best for our older people.

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