Which Models Will Improve Patient Outcomes?

Whereas population health focuses on the outcomes within a specific group, personalized medicine seeks to customize care delivery at the individual level. A recent discussion between Dr Eric Topol, director, Scripps Translational Science Institute, and Dr Farzad Mostashari, former director of the Office of the National Coordinator for Health Information Technology, highlighted the diverging opinions of where future healthcare models need to go.

Dr Topol says that innovations in personalized medicine could optimize medication and treatment to complement a patient’s genetic makeup, thereby reducing costs in the long term. However, Dr Mostashari argued there is much-needed merit in population health, suggesting that there needs to be consistency in treating chronic conditions such as diabetes. The disagreement between the two seems to center of the question of how providers can integrate population health while still doing what is right for a particular patient-doctor relationship.

“There is a tension there between personalized medicine at its best, precision medicine, which we all want to get to. We want to get to a place where there is evidence. And if there is not any evidence, we must learn from every individual healthcare encounter in a way that benefits the world’s knowledge and contributes to the world’s knowledge, right?” said Dr Mostashari when interviewed recently along with Dr Topol. “That is how I think of where we are going to be with smart health and where we are today, which is pretty blunt, evidence-based science that says things like ‘people with diabetes should be taking an aspirin or they should have their Pneumovax vaccine or be on a statin.’ And there is tension between where we want to go and the bluntness of these guidelines.”

Whether across populations or at the individual level, improving patient outcomes will require a fundamental shift in many care organizations, especially as reform initiatives are integrated into current healthcare models and policies. At the U.S. News & World Report Hospital of Tomorrow event this past week, discussion was squarely focused on such initiatives as health leaders related their approaches to achieving better outcomes through patient engagement at all levels of the industry.

Dr Clifford Ko of UCLA Medical Center and director of the NSQIP surgical registry, for instance, said that the “one-size-fits all” approach is no longer viable. Dr Ko agreed with the other session speakers that there is great value in collecting patients’ data across hospital systems. He said that in a study of 8 major hospitals, researchers found there was no common factor associated with surgical site infections in every center. Even though the ways in which the hospitals improved their outcomes differed, they all were able to utilize data to improve patient outcomes and reduce risk in patient procedures.

It seems that with healthcare reform and utilizing data to improve patient outcomes, a medley of approaches is best.

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