With mounting pressure on health care organizations to provide high-quality care while containing costs, there’s been an increasing reliance on using health outcomes research to identify the most effective interventions and incorporate them into clinical practice. As such, health outcomes research can provide a valuable resource to help clinicians make strategic treatment choices that will ultimately benefit patients and systems on many levels.
“Health outcomes research studies the end results of health care services, providing evidence for the value of specific medical treatments or interventions that can be used to make better decisions and improve health care,” explains Marcia A. Testa, MPH, MPhil, PhD, who serves as Senior Lecturer on Biostatistics for the Harvard T.H. Chan School of Public Health. Testa and Donald C. Simonson, MD, MBA, MPH, ScD, of the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women’s Hospital and Harvard Medical School, co-direct a program called Measurement, Design, and Analysis Methods for Health Outcomes Research offered by the Harvard Chan School’s Executive and Continuing Professional Education (ECPE) division.
Incorporating Patient-Centered Outcomes
Testa points out that some of the most effective examples of health outcomes research consider patient-centered outcomes; incorporating the patient’s lifestyle, preferences, and voice in applied research is critical, since these aspects impact treatment compliance and, therefore, outcomes. “‘Patient-reported’ outcomes are a big part of ‘patient-centeredness,’” she stresses.
Health outcomes research can also play an important role in identifying disparities among different populations and guiding clinicians on taking action to help even the playing field for patients of all socioeconomic groups and backgrounds.
Further, patient-centered outcomes, including those reported by patients themselves, enable “people and their caregivers [to] communicate and make informed health care decisions, allowing their voices to be heard in assessing the value of health care options,” according to the Patient-Centered Outcomes Research Institute’s (PCORI) website.
Health outcomes research can also play an important role in identifying disparities among different populations and guiding clinicians on taking action to help even the playing field for patients of all socioeconomic groups and backgrounds.
Utilizing the Findings
With so much to gain, it’s essential that prospective investigators understand the scope of health outcomes research and recognize how to utilize it in their efforts in the most appropriate way.
Specifically, when researchers understand how to properly design and implement health outcomes research studies and to synthesize the data, the findings can be used in a multitude of situations. For instance, the information can help practitioners to select the most appropriate treatment options for individual patients that take into account their specific needs and situations. The findings can also help to identify gaps in treatment choices for different patient populations. In addition, the data can be used to determine any interventions that are over- or under-used by population groups in order to help providers develop evidence-based treatment strategies that bring value-added care, Simonson says.
But of course, even the most well-designed and executed health outcomes research projects will only be effective if clinicians and other medical providers know how to apply the data on patients in a clinical setting. In fact, the process of translating and using research findings is itself a relatively new field of research, called implementation science. This field studies methods to promote the adoption and integration of evidence-based practices, interventions, and policies into routine health care and public health settings. It is the natural “next step” in health outcomes research, and PCORI even offers special funding opportunities to previous PCORI research recipients for “Dissemination and Implementation” of their research results.
Bridging Challenges That Exist
To help bridge some of the challenges that exist in applying health outcomes findings, Simonson, Testa, and their colleagues are currently working on a grant project funded by PCORI titled “Benchmarking the Comparative Effectiveness of Diabetes Treatments Using Patient-Reported Outcomes and Socio-Demographic Factors,” which was recently featured at the American Diabetes Association’s (ADA) 2017 annual meeting.
With diabetes currently affecting 11.3 percent of Americans aged 21 and older, causing high blood glucose levels that can lead to a variety of serious health issues, many patients require specific dietary requirements and regular exercise, along with glucose monitoring and treatments including insulin. But while clinical trials measure the effectiveness of different treatment approaches in a general way, most physicians typically don’t alter their treatment approach to respond to these variables for each individual.
While clinical trials measure the effectiveness of different treatment approaches in a general way, most physicians typically don’t alter their treatment approach to respond to these variables for each individual.
“There are many factors that influence how well patients are able to comply with these requirements including age, education, income, and cultural and lifestyle issues,” Simonson says. Further, any side effects of treatment, or any other co-existing conditions, may also impact a person’s likelihood to follow a specific treatment regimen. Yet these aspects are largely unexplored when developing treatment strategies.
The Need for Individualized Treatment Plans
“Since diabetes patients act and respond differently to treatment due to many reasons, health care providers often cannot advise patients as to how they might respond given their personal characteristics simply because they do not have the required information,” Simonson points out.
The reason this crucial information is lacking is that “typically, no one clinical study can separate out the results by all the patient characteristics that might affect treatment,” Testa offers. “In addition, clinical drug trials do not typically measure how patients feel or how satisfied they are with their assigned treatment,” she says, adding, “In most clinical trials, the ‘true voice’ of the patient is usually silent.” To better capture this important component, Testa, Simonson, and their colleagues are pooling existing databases of diabetes patients with information gathered online and through social media.
Educating Physicians to Strengthen Treatment Efforts
“We will incorporate the results of our findings and analyses into a web-based application that will allow clinicians to predict how likely a patient will be to respond given their individual characteristics, and will allow patients and physicians to benchmark their progress against others with similar characteristics to improve the quality of care,” Testa says.
The hope is that, moving forward, more investigators and practitioners will recognize the importance of considering patients as individuals when developing treatment strategies to create a more personalized approach that will likely achieve better results.
The researchers are also using their findings to develop an online “toolkit” designed to educate physicians on how to interpret health outcomes data and put the findings into practice in the patient-care setting.
The hope is that, moving forward, more investigators and practitioners will recognize the importance of considering patients as individuals when developing treatment strategies to create a more personalized approach that will likely achieve better results.
Improving the Decision-Making Process
“A diverse and growing number of groups, including employers, health care delivery organizations, insurers, pharmaceutical companies, and government agencies, currently use actionable data provided by health outcomes research to guide their decisions about different treatment options and interventions,” Testa says. This widespread use should prompt prospective investigators to make a concerted effort to consider this element in future research projects. “By using health outcomes data to guide the decision-making process across organizations, this can increase the value of every dollar spent on health care,” she adds.
Harvard T.H. Chan School of Public Health offers Measurement, Design, and Analysis Methods for Health Outcomes Research, a program focused on designing, implementing, and analyzing health outcomes studies. To learn more about this opportunity, click here.