2014-09-18-奥纬咨询-Measuring_Wellness_11页_314kb

报告摘要

Summary of "Measuring Wellness" (September 2014)

Core Content

This document explores the concept of measuring wellness as a critical tool for transforming the health and social care system in England from a reactive to a proactive model. It emphasizes the importance of using wellness metrics to drive systemic change, improve outcomes, and ensure the effective use of public funds. The focus is on developing a comprehensive, consistent, and applicable measure of wellness that can be used across all public services and population levels.

Main Points

Shift from Reactivity to Proactivity: The health and social care system needs to move away from reactive care (focused on treating illness) to proactive care (focused on prevention and wellness). This shift is necessary for improving outcomes and making services more affordable and effective.
Need for Systemic Metrics: There is a growing recognition that traditional "sickness and repair" metrics are insufficient. A new set of metrics is needed to measure population wellness, not just individual outcomes. These metrics should support system-wide transformation and accountability.
Patient Activation as a Predictor: Patient activation, defined as an individual's knowledge, skill, and confidence in managing their health, is a stronger predictor of health outcomes than factors like age or ethnicity. It is linked to positive health behaviors and better clinical indicators.
Wellness and Health Outcomes: There is a strong correlation between psychosocial wellness and physical health outcomes. Studies show that higher levels of wellness are associated with better health, including reduced mortality and improved quality of life.
Economic Case for Wellness: A US study demonstrated that patients with lower activation levels cost significantly more in healthcare. This highlights a strong economic incentive for improving patient activation and wellness.
Candidate Metrics: Two key wellness metrics are proposed:
- WHO-5: A survey measuring psychological well-being, primarily used in primary care for depression screening.
- WEMWBS: A more comprehensive survey with 14 questions that assesses a broader range of wellness attributes, including coping, decision-making, and social connection. It has shown strong correlation with health outcomes and is supported by existing data in England.
Implementation of Wellness Data Collection: A self-assessment survey like WEMWBS could be used to collect baseline wellness data across the population. This could be supported by mobile/web-based technologies and low-tech methods to ensure broad coverage and cost-effectiveness.
Complementary Metrics: In addition to wellness metrics, hard metrics like Emergency Bed Day Usage per 1,000 65+ population should be used to evaluate the effectiveness of care models. This metric has been shown to be a powerful indicator of the efficiency of elderly care systems.
Use of Wellness Data for System Transformation: Robust wellness data can help identify populations with low wellness, target resources effectively, and foster collaboration between different sectors (healthcare, social services, education, etc.). It can also support the evaluation of service innovations and hold leaders accountable for improvements in wellness and health outcomes.

Key Information

WEMWBS is considered the more powerful tool for measuring overall wellness in populations, with a broader set of questions capturing key elements of wellness linked to patient activation and health outcomes.
The average WEMWBS score in England in 2012 was 52.5 for men and 52.2 for women.
Physical activity is positively correlated with higher well-being scores.
Emergency Bed Day Usage is a critical metric for evaluating the performance of elderly care systems, with South Devon and Torbay CCGs showing the lowest usage in 2011.
Rural CCGs tend to perform better than urban CCGs in terms of emergency bed day usage, suggesting opportunities for improvement in urban areas.

Desirable Characteristics of a Wellness Metric

Simple and easy to understand
Broadly accepted and supported by strong evidence
Proven to be responsive to change following interventions
Applicable across all public services
Applicable at all population levels (national, regional, local, individual)
Cost-effective and quick to implement

Conclusion

A consistent and systematic approach to measuring wellness can serve as a powerful tool for transforming the health and social care system in England. It can drive collaboration, support innovation, and enhance accountability for the effective use of public resources. The document advocates for the use of WEMWBS as a primary wellness metric, complemented by other hard metrics, to support a shift from reactivity to proactivity in care delivery.

References

Chida Y, Steptoe A. Positive psychological well-being and mortality: a quantitative review of prospective observational studies. Psychosom Med. 2008 Sep; 70(7):741-56
World Health Organization. Promoting Mental Health (2005)
Department of Health. Healthy Lives, Healthy People: our strategy for public health in England (Nov 2010)
Department of Health. No Health Without Mental Health: a cross-government mental health outcomes strategy for people of all ages (Feb 2011)
Judith Hibbard, Helen Gilburt. Supporting people to manage their health—An introduction to patient activation (May 2014)
Judith Hibbard, Jessica Greene. What The Evidence Shows About Patient Activation. Health Affairs, Feb 2013
Bech P, Olsen RL, Kjoller M, Rasmussen NK. Measuring well-being rather than the absence of distress symptoms. Int J Meth Psychiatr Res 2003; 85-91
The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation (Health and Quality of Life, 2007)
Health Survey for England – 2012: Chapter 5, Well-being (Health and Social Care Information Centre, Dec 2013)
Maheswaran H, Weich S, Powell J et al. Evaluating the responsiveness of the Warwick Edinburgh Mental Well-Being Scale (WEMWBS). Health and Quality of Life Outcomes. 2012
Candace Imison, James Thompson, Emmi Poteliakhoff. Older people and emergency bed use—Exploring variation (The King's Fund, Aug 2012)