Designing Care for Outcomes

For Augustine Agocha, MD, Chief of the Division of Cardiovascular Medicine at the University of South Carolina (USC) School of Medicine, there is nothing more satisfying than getting a patient’s blood pressure, cholesterol, or diabetes under control. “When you set a goal for a specific outcome and design your care to achieve the outcome, there’s a great sense of accomplishment for both the physician and patient,” he explains.

This philosophy, designing care for outcomes, seems fairly simple. Yet all too often, traditional performance measures are based on physicians following a specific process—prescribing a statin drug for high blood cholesterol for example—rather than on the accomplishment of the desired outcome. “As it stands now, performance measures are satisfied simply by prescribing the drug. There is no mechanism in place to see if the patient’s cholesterol is actually improved. The focus is too much on actions and not enough on results,” says Dr. Agocha. “Physicians and other caregivers must place more emphasis on the destination and less on the road taken.”

Dr. Agocha’s destination since joining the USC School of Medicine in November 2008 has been to introduce and implement the philosophy of designing care for outcomes, or as he puts, “Getting the job done.”

One performance measure has to do with hospital readmission rates after discharge for a heart-related event. The goal is to keep patients from being re-admitted for at least 30 days. Dr. Agocha believes this is a realistic measure of performance as it challenges caregivers to develop a plan for a specific outcome.

“By identifying this desired outcome, you can design, develop and implement a concrete system of care that gets you there. It is a much more manageable approach because the end result is well defined,” he says.

The approach applies to both clinical and academic medicine. Physician and patient work together toward a specific result, a set target for cholesterol for example, which in the long run achieves a better overall outcome. “By focusing on the physician patient relationship and setting specific, achievable goals for care, we get better outcomes, and a safer, better healthcare system,” says Dr. Agocha. The USC School of Medicine’s Division of Cardiology and its new Center for Cardiovascular Disease Evaluation and Management is now instilling its medical students and residents with the designing care for outcomes philosophy with a heavy emphasis on achieving results.