new ways to look at health and healthcare outcomes: focusing on patients’ perspectives and values

New Ways to Look at Health and Healthcare Outcomes: Focusing on Patients’ Perspectives and ValuesPatricia Katz, Jonathan Showstack, Ed Yelin, James Smith, and colleagues in the PRL-IHPS and the Arthritis Research

GroupIssue: Traditionally, patient health status and

effects of healthcare were based on outputs of the medical system

Newer trends focus on patients’ perspectives:• Satisfaction with medical care• Self-reports of symptoms and functioning• Personal values and experiences

PRL-IHPS Faculty have led efforts to

incorporate patient-centered measures in a

variety of arenas

Example 1: Fertility Experiences Project• Quantified time expenditures and out-of-pocket costs of

infertility treatment, as well as total medical costs• Identified risk of depression following treatment failure and

social impact of infertility• Found disparities in access to infertility treatment

Implications:• Current policies surrounding infertility treatment produce

huge disparities in access to care and provide incentives for treatment options that produce greater costs after conception (i.e., costs of multiple births)

Example 2: Measurement of Disability andFunctioning

• Standard measures of disability focus on low levels of functioning, such as ability to eat or rise from toilet

• Patients experience disruptions in activity long before these basic activities are affected

• New measure of disability asks about effects of health on a range of activities, from very basic activities to household tasks to social and recreational activities and work, and allows people to express the value of the activity

Implications:• Measures impact of health that are important to patients• Focused on patients’ functional goals• Can be used to target interventions before more serious

disability occurs