Asan Akpan is a community geriatrician in Merseyside and research fellow for the Older Persons Working Group at the International Consortium for Health Outcomes Measurement (ICHOM). In this follow up blog, he summarises ICHOM’s work on developing the first set of international health outcomes for older people. These outcomes included participation in decision making, autonomy and control, mood and emotional health, loneliness and isolation, pain, activities of daily living, frailty, time spent in hospital, overall survival, carer burden, polypharmacy, falls and place of death.
The goal of the Older Person Working Group was to define a minimum set of outcomes for evaluating healthcare for older people. The group aimed to present a balanced and comprehensive review of measurement within a recommendation that was feasible to implement in routine clinical practice. An additional goal was to facilitate the creation of data that can be meaningfully compared for analysis, benchmarking and shared learning. The group included patient representatives, measurement experts, clinical, social and psychological researchers, and other opinion leaders in the field. Countries represented by the Working Group included Australia, Botswana, Canada, Germany, Holland, Sweden, Switzerland, Taiwan, Peru, the United Kingdom, and the United States of America.
A consensus-based modified Delphi technique, which is an iterative, multistage process with the aim to actively transform opinion into group consensus was utilised to develop the Standard set of health outcomes. Over 10 months, the working group met 8 times over teleconferences. A specific predefined topic was discussed during each teleconference. Each call was preceded by a literature review, review of measurement approaches by longitudinal ageing surveys and focus groups with older persons and carers. The outcome measures were prioritised on; the basis of representing the end results or ‘outcomes’ of care, what is important to older persons and their families, what is feasible to capture and outcomes that can be modified through quality improvement.
Following each call, the discussion content was collated into online surveys. Working Group members were asked to submit their feedback and votes via a web-based questionnaire. Decisions resulting from the surveys required a majority vote. The outcomes chosen were based on congruency across findings from the registries, surveys, literature searches and engagement with older persons. A minority were chosen based on the consensus experience of the working group members from the collated findings.
This international standard of health outcomes assessment has the potential to improve clinical decision-making, to enable better commissioning and service integration, to facilitate the exchange of scientific knowledge, and overall to enhance the care of older people.
A reference guide is available online that further describes the recommended instruments, data sources and provides detailed information via www.ichom.org. A paper is also being prepared for publication in a peer-reviewed journal that will provide more details and references to the whole project.
In the meantime Dr Charlotte Roberts, ICHOM Standardisation and Operations Director (firstname.lastname@example.org) can be contacted for any further queries or information.