Claims adjusters have a public image as hard-headed, cynical, worldy-wise business people. (Think Edward G. Robinson in Double Indemnity, if your memory stretches back that far.) Workers’ comp adjusters understand something, however, that health execs and policy types often overlook: the “soft factors” of patient belief and comprehension have a dramatic impact on case outcomes.
Comp claim adjusters – at least the good ones – develop an understanding of patient psychology because it’s in their best financial interest to do so. A patient who’s frightened that he won’t get good care may get a lawyer, driving claim costs up. A patient who’s angry she can’t get appointments scheduled may delay her return to work. A patient who’s confused may not recover effectively.
A smattering of recent articles and developments shine light into different corners of the “patient’s mind” issue.
Writing in Medscape, Keith J. Petrie et al. (free enrollment required) review recent litererature regarding “the influence of illness perceptions on outcomes in patients with medical conditions.” The more interesting citations address the influence of disease perception on outcomes, as well as the effect of beliefs about need for treatment and their impact on treatment compliance (e.g. taking medications for AIDS treatment). Their conclusion – that “illness perceptions have been shown to have important associations with outcomes in a range of acute and chronic illnesses” – places a burden on physicians to communicate effectively with their patients.
The San Francisco Chronicle looks at a new initiative to provide “health care consumers” (I still can’t warm up to that term) online, searchable data on on quality of care and patient satisfaction by type of treatments for California hospitals:
While a dizzying array of hospital report cards already exists, the developers of the Web site CalHospitalCompare.org (www.calhospitalcompare.org) say it’s the most comprehensive site for people to use when making decisions about where to receive health services.
“There is no other Web site … that combines data from this many sources,” said Dr. R. Adams Dudley, project director for the Institute for Health Policy Studies at UCSF, which collected and analyzed the data for the site.
I used the site to compare two nearby hospitals and found it easy to use and readily navigable, unlike many other “health consumer” sites. The main reason for that is that it’s reporting very little about each hospital. All it tells you is how care was rated in three simple areas – quality, timeliness, satisfaction – in a way that easily lets you compare hospitals by type of condition.
Sites like this are a model for more complicated ventures, and could ideally create “feedback loops” that force hospitals to improve in areas where they’re deficient. In that sense, HHS Secretary Mike Leavitt was right when he said that “our goal isn’t just to digitize healthcare data, it’s to create a ‘system’ out of a sector. We can’t do that without healthcare IT.” But I start to worry when politicians start to talk about “aliging incentives to choose high quality, low cost providers.” It’s the right idea, but I get concerned about execution.
On the low-tech side of the spectrum, Gloria Mayer at Healthleaders discusses the impact of poor literacy on health outcomes in chronic conditions. These conditions are significant cost drivers in health, and our system is designed to concentrate more on high-tech and high-pharma solutions than it is to the more prosaic, but sometimes far more cost-effective, “human touch” efforts that impact both cost and outcome.
Sensitivity to literacy issues is important, whether you’re considering instruction sheets for surgical aftercare, pamphlets on your newly-diagnosed condition, or hospital signage. (Lost, confused, and frightened patients may not return for needed ongoing treatments.)
- Patients’ minds can be used to improve outcomes.
- “Provider profiles” need to factor in the doctor’s ability to communicate to the patient in a way that is clear, reassuring, and leads to better compliance. (Short of patient surveys, duration-of-care and other markers can be used to measure a doctor’s “bedside manner” and its impact on treatment effectiveness.)
- When it comes to searchable online data, simpler is better.
- Literacy management in health may not be as glamorous as searchable “health care consumer” websites, but it may do just as much good in the long run.