Mattias Abrahamsson, vice-president for incontinence care at Essity, discusses the need for outcome measures to drive standards in continence care and explores how a new set of KPIs could improve the lives of people living with this condition.
Incontinence affects approximately 4-8% of the global population, which amounts to the lives of about 400 million people today.1 Incontinence can affect men and women of all ages, but the incidence increases with age. It is the most common medical problem affecting the ageing population, and it is only set to increase as current demographic data suggests that the over 80s age group is the fastest growing segment worldwide.2
Continuous improvement of care for people with incontinence
Much has been done to improve the lives of people with incontinence in recent years. Despite clinical advances improving the range of treatment options available, today relatively few people with incontinence find a cure. This makes an emphasis on high-quality care even more critical. People who need to manage their condition daily need effective toileting and containment strategies, tailored to their individual needs.
Given the lack of an international consensus on what good continence care looks like, it is even more difficult for health and social care systems to know what they should be aiming for or how standards should be measured.
Incorporating a value-based care approach
It is crucial for health and care systems to have a clear understanding of what a good standard of care looks like in order to measure health outcomes. A new model is rising in prominence around the world called the ‘value-based healthcare model’.3 It measures health outcomes and patient satisfaction against the cost of delivery. But ‘value’ is about more than cost; it is about the quality of the service and ultimately the quality of life (QoL) achieved by patients.
When it comes to conditions like incontinence, QoL is highly subjective and varies according to the particular situation. There can be a lack of consensus around what ‘good’ looks like in the context of someone who has to live with it on a daily basis, and how this can be achieved given current resourcing constraints. Too often there is a fear that cost-effective and affordable care are mutually exclusive concepts. It is time to address these misconceptions so we can bridge the gap between simply ‘surviving’ and ‘thriving’, and in doing so create a model for care delivery which is not only better for patients but also provides greater value for health systems.
Study on outcome measures and key performance indicators (KPIs)
A groundbreaking consensus-based study has identified for the very first time what a set of outcome measures and KPIs might look like, which care providers, health and social care policymakers and payers can use to guide the delivery of daily continence management services, measure success, and evaluate performance over time. “Measuring Outcomes to Improve the Management of Continence Care’ was initiated by Essity, led by an expert panel and facilitated by KPMG’s Global Strategy Group. Based on a comprehensive literature review to develop an initial ‘long list’ of possible KPIs, the study included stakeholder engagement with over 60 people representing patients, carers, health professionals, policymakers and payers. This culminated in a definitive list of 14 recommended KPIs which are relevant and practical for use in the full range of care settings and for health and social care systems to measure.
The 14 KPIs are divided into different areas: one KPI is structural, five KPIs are around process and eight KPIs are outcome related. They can be applied to measure care for people living with incontinence who are independent or care-dependent (who may or may not be able to communicate their needs).
The outcome related measures cover clinical, QoL and economic measures, ranging from skills-based KPIs (the proportion of staff with the skills to perform a continence assessment and prescribe a toileting and containment strategy), to the cost of admission and re-admission related to the delivery of poor continence care.
The QoL outcomes relate to people with a prescribed toileting and containment strategy who report sustained or improved emotional wellbeing or who report ‘good’ or ‘acceptable’ levels of access and support to toilet facilities in their daily life.
Quality care is cost-effective
Improving QoL through good care does not necessarily mean increasing the cost of care provision. In fact, it can be cost saving. Thriving patients often require less care, particularly over the longer term. They may need fewer, potentially costly interventions and are less at risk of requiring emergency care or hospitalisation. They can also avoid the need to be institutionalised so they can remain independent at work and at home (which is better for their emotional wellbeing and dignity).
If they are able to continue using a toilet as part of an effective care routine (whether assisted or by themselves), this can represent a better and more efficient use of resources – aside from the obvious benefit to the individual.
But the achievement of genuine QoL requires a whole system approach which is recognised by additional clinical and economic indicators. These range from the level of training for staff to the cost of poor continence care.
Investing in the right resources
Investment in the right resources will allow for better outcomes for patients, carers and health and social care systems. This includes making the most of available technology and investing in training to enhance the competence of nurses and professional carers so they are better equipped to make accurate assessments of patients’ needs. Specifically, educating patients and professional carers/nurses on the range of options at their disposal can result in better-tailored care provision that meets the individual’s needs alongside more effective delivery of toileting and containment strategies.
Integration into health policy
The output from the ‘Measuring Outcomes to Improve the Management of Continence Care’ study can make a tangible contribution to the improvement of care provision for people living with incontinence if adopted by national health and social care systems across the globe. European countries are encouraged to integrate KPIs into existing national quality frameworks to promote an improvement in local healthcare delivery.
The set of KPIs produced by the study will give care providers and policymakers, for the first time, clear outcomes to aim for and a way to assess continuous improvement for people living with incontinence. In addition, it will facilitate the creation of a powerful bank of benchmarking data to provide the basis for value-based healthcare procurement of toileting and containment strategies.
Ultimately it is hoped that this study will inspire fresh thinking on the things that providers should be focusing on and give them tangible measures in the form of KPIs which can be embedded into existing quality frameworks.
It is about making the best of what you have and making it more effective, focused and efficient. The sooner it can be implemented, the sooner more people with incontinence will be able to enjoy living with the independence and dignity that they all deserve.
1 Irwin DE, Kopp ZS, Agatep B, Milsom I, Abrams P. Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. BJU Int., 2011; 108: 1132-8.
2 Wagg AS, Newman DK, Leichsenring K, van Houten P. Developing an Internationally-Applicable Service Specification for Continence Care: Systematic Review, Evidence Synthesis and Expert Consensus. PLoS ONE, 2014; 9(8): e104129. doi:10.1371/journal.pone.0104129
3 Presentation on Value-Based Health Care and the Role of Outcomes Opportunities for the OECD, Professor Michael E Porter, http://www.oecd.org/els/health-systems/Item-3b-Improving-Health-Care-Value-Porter.pdf
Vice-President for Incontinence Care
This article will appear in issue 5 of Health Europa Quarterly, which will be published in May.