Health Outcomes that Matter to Patients
April 22, 2024
In her clinical and research work, Dr. Shannon Jackson never loses sight of this objective
Dr. Shannon Jackson wears enough hats to fill a closet. A hematologist specializing in inherited and acquired bleeding disorders, Shannon practices at St. Paul’s hospital in Vancouver. When not in the clinic, she oscillates between her duties as Medical Director of the Provincial Adult Bleeding Disorders Program, co-founder of West Coast Hematology, and clinical professor at the University of British Columbia. Having completed a Master’s degree in Health Care Transformation at the University of Texas’s Value Institute for Health and Care, Shannon also holds the title of Physician Lead for Value Based Health Care (VBHC) at Providence Health Care.
PATIENT-CENTRIC OUTCOMES
As someone who straddles the healthcare improvement, clinical, research and administrative worlds, Shannon is keenly aware of the cracks in Canada’s current access landscape. Treatments for her patients come from different silos, “which can complicate access,” she says, noting that oncology tends to get more attention than non-malignant blood disorders. “Every time I’m in the clinic, I fill out forms to enable my patients to access drugs.” She may or may not succeed: “In order to access some treatments, patients need to have failed several other treatments or to have tried surgery, which makes access very challenging.” In brief, “the system operates in a void of shared health outcomes that matter to guide access decisions.”
Not content with the status quo, Shannon has taken steps to change it. Notably, she seeks to broaden the scope of data collection to include patient-reported outcome measures (PROMs). To this end, she has been working to bring PROMS into the patient care cycle at Providence. “We have a whole Value team that is working to integrate PROMs into care, right at the time the patient is receiving treatment.”
But which PROMs? Shannon and her team have been working with doctors, nurses, physiotherapists, and above all, patients, to establish the most meaningful PROMs to collect and analyze. Through this exercise, they learned that “earlier PROM data we collected was, unfortunately, never being used in clinics to help guide treatment.”
The new emphasis on PROMS requires patients to take extra time to fill out questionnaires and answer questions before their clinic visit. “We need to honour their gift of time by doing our part, which is to use their data to improve their health outcomes – specifically the ones that matter most to them,” Shannon insists. She sees the work as key to understanding the outcomes that meet patients’ actual needs, rather than the needs they are assumed to have. A part of this work involves measuring outcomes for communities facing the biggest health inequities, such as Indigenous populations, and using the findings to guide care that aims to reduce the equity gap.
“We need to honour patients’ gift of time by doing our part, which is to use their data to improve health outcomes that matter to them.”
The PROM work dovetails perfectly with Shannon’s passion for VBHC, as exemplified by a recent partnership between the Providence Value team and orthopedic surgeons. To reduce wait times for non-operative shoulder pain consultations, a rapid access shoulder clinic enabled the timely assessment of chronic shoulder pain by an experienced physiotherapist, with support from two orthopedic surgeons. With the establishment of the clinic, the median time from referral to consultation dropped from two years to less than 3 months.
The initiative included gathering information on which health goals and outcomes meant the most to patients. Participating patients made it clear they placed the highest value on maintaining independence, continuing to work, and living without significant discomfort. The clinical team selected PROMs to reflect these patient perspectives, and incorporated meaningful measurements into pre- and post-clinic care. Conversely, patients were most troubled by long waits, uncertainty, lack of information, and minimal collaboration among health providers. In response to this feedback, the team created support materials to inform patients that “they would be seen by an experienced physiotherapist who works with a surgeon to ensure quality care, and that their health goals and outcomes would be measured,” Shannon explains. When deemed necessary, the team would expedite a consult with a surgeon.
Transformations like the ones Shannon envisions often sputter at the implementation level, but Shannon and her collaborators at St. Paul’s have this covered. “We’re developing tools to enable cross-talk between silos and ensure consistency, and we’re intersecting with our quality improvement teams to make sure everything is operating as it should,” she says, while conceding that “it will take years for all this to be fully implemented.” With Shannon on the case, we can be confident it will happen.