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Different is necessary to make healthcare better

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By Chad Leaver

Every day, hundreds of thousands of Canadians access healthcare services. Many undergo critical life-saving procedures, while others receive important routine and follow-up care. With their incredible training and practice, clinical and professional healthcare teams play the leading role in delivering compassionate, effective and safe care to Canadians. Next to this everyday excellence, the reality is that many children, adults and seniors across Canada wait too long to access the care and treatments they need. If waiting wasn’t hard enough, the stark truth is that 5-million Canadians don’t have access to a family doctor or primary care team – a critical node to wellness.

Long wait times to access care or services for clinical procedures is a known contributor to reduced functional and physical wellness for Canadians diagnosed with one or more health condition. Declining health while waiting increases healthcare utilization and costs, making it even more challenging on the person and care interactions. Many lose the race. In 2021−22, 13,581 patients across Canada died while on waitlists for surgical, diagnostic, or clinical procedures.[1]

What steps can we take to better support Canadians?
Value-based healthcare (VBHC) is a systems approach to healthcare delivery, management and coordination, currently embraced by many of the world’s most advanced healthcare systems. It represents a shift away from volume-based (fee-for-service) funding models towards outcomes-based funding delivered by a patient-centric care model. This model features integrated and inter-professional healthcare teams serving the needs of a person along their care journey.

 

What’s unique about VBHC is how the model systematically measures and honours outcomes that matter to patients and as a result improves shared decision-making. It also includes a transparency to the costs of care, supporting sustainable operations and informing the effectiveness of current and new evidence-based treatments, technologies, and service innovations.

What are patient outcomes and why are they important?
Evidence shows that considerable numbers of healthcare providers underestimate (or even dismiss) pain and suffering that patients experience. Symptom underestimation in cancer, specifically, has been associated with inadequate pain control from advanced treatment regimens, poor quality of life, poor compliance with treatment recommendations, and reduced survival.

Patient Reported Outcomes (PROs) are defined as “changes in health that result from specific health care investments or interventions.” Facilitated by structured survey tools and ‘experience dialogues’, PROs can be completed by patients themselves or by caregivers, clinicians or social care professionals supporting a patient’s circle of care.

Systematic collection and use of PROs in routine practice can help ensure that symptoms are identified, acknowledged, and addressed in a timely fashion. The benefits include improved patient–provider communication, better symptom management and quality of life, higher patient satisfaction; and in cancer care – overall survival.

Hospitals and care organizations across Canada, including the Jewish General Hospital in Montreal; and St. Paul’s Hospital, in Vancouver – among others, have demonstrated that it is feasible to integrate PROs into routine care. If integrated with hospital and patient information systems, automated alerts based on patient or caregiver completed surveys can trigger timely care management pathways and reduce emergency visits – catching potential acute events before they happen. So why aren’t the integration of PROs to patient care and system management routine practice?

In the most recent report from The Conference Board of Canada’s Value-Based Healthcare Canada research centre looking at PROs in colorectal cancer treatment, highlights the value of their use with specifics to guide organizations on standardizing the routine collection of PROs. These range from data management, information system interoperability and advanced analytics.

When we hear reports that provinces don’t want to share outcomes data in support of new federal transfer agreements, the question it begs is: why not? A  2022 survey[2] of over 2,000 Canadians showed 82 per cent are willing to share their health information to support improving the performance of the health system; and strategies to improve their own health or advance scientific research. It’s clear that Canadians are open to participating in meaningful efforts to contribute to reporting outcomes that matter to them to improve health system performance, management, research and discovery.

With growing pressure to ensure the sustainability and resiliency of Canada’s healthcare systems and supply chains, VBHC approaches across Canada are gaining momentum. Yet, broad system transformation and monitoring of progress is needed to truly realize improved access to care and the best health and wellness outcomes for patients, families, and health professionals alike.

The economic and social imperative for increasing the value and accountability of federal, provincial, and yes – private healthcare investments – that will together sustain Canada’s health ecosystem has never been more important. The survivability of Canada’s health systems rests on it. The fact is, different is necessary.

Chad Leaver is the Director, Health at The Conference Board of Canada.

[1] Colin Craig, Policy Brief: Died on a Waiting List, December, 2022.

[2] Canadians’ Perspectives on Digital Health Privacy (November, 2022).  https://leger360.com/surveys/canadians-perspectives-on-digital-health-privacy/#:~:text=More%20than%20half%20of%20respondents,protect%20their%20personal%20health%20information.

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