By Douglas L. Wood, M.D.
Measuring health care has itself become a multi-billion dollar industry with multiple goals. Some measurement is intended to improve clinical care, some is used as a basis for awarding bonuses or imposing penalties, and some is used to help guide Medicare payment. Now, Medicare and other groups want even more measures.
Does all of this measurement really help people better understand their health
? Does it help them understand how the care they receive will help them achieve better health?
Health to most people is not measured simply in clinical terms. Rather, it more often refers to a balance of things that allow them to function in the way they would like. For example, rather than considering a complex measure of clinical elements for diabetes and being labeled a diabetic, people with diabetes are more interested in how they can live their lives without their ailment becoming a burdensome intrusion.
Or consider the limitations of disease-specific measures
for people with multiple conditions. That same person with diabetes may have an entirely different perspective about what is important to their health if they suffer a heart attack or learn they have cancer. Clinical measures developed for one disease do a rather poor job of capturing the impact of multiple diseases on the way a person functions.
Perhaps it is time to critically reassess our measurement strategies
, especially when it comes to trying to understand the various dimensions of health. Rather than try to collect and report dozens of measures that are disease-specific and then struggle to explain the problems with their interpretation, it is time for us to be more purposeful and parsimonious
in our measurement activities.
We should start with a basic approach to measurement of health that includes four dimensions for all patient-reported outcomes:
1. role functioning
2. physical health
3. mental health
This approach would force us to reframe our perspective from health care to health.
Douglas L. Wood, M.D., is medical director for the Mayo Clinic’s Center for Innovation. He is also a consultant on cardiovascular diseases and chair of the MMA’s board of trustees.