STEP 3

Decide which target to focus on

Types of targets

Rationale

A target represents the desired goal. In CDM Quality Care, the first target involves implementing the desired strategy or interventions that will diminish the gaps in care. The second target involves the outcomes, meaning the end results; in this context, what happens when the desired interventions are indeed implemented.

 

Target

Intervention

Target Outcomes

Intermediate

Ultimate

Development, formalization & update of programs and tools

 

 

 

 

 

Access to services (references & follow-up)

 

 

 

 

 

ER visits

Optimal use of Pharmacological Treatment

Hospitalization

Readmission

Implementation of programs and tools

  • Training
  • Coordination

Use of spirometry

Quality of life for patients

Satisfaction (Patients and health professionals)

Figure 1: Intervention targets, Target outcomes, (referrals and follow-up), Optimal use of pharmacological treatments, Use of spirometry tests, Patient’s quality of life, (patients and health care professionals

 

Intervention targets

In this section we will discuss how to define your targets based on gaps in care, perceived obstacles and the strengths that are specific to your institution. Intervention targets may include developing and formalizing programs, new tools, training, etc., but also adapting and adjusting existing programs within a maintenance perspective.

 

Target outcomes

These are the targeted measures that the intervention is designed to impact. Although the term includes the word "outcomes" these measures may be designed to affect a process (intermediate outcomes). This involves how the program is operating, i.e., the process.

However, the ultimate outcomes (changes that occur as a result of your intervention/program/pathway) are to improve patient health and health care services use. Be sure to have a mix of both types of outcomes, since each of them has certain limitations in terms of feasibility and evaluation, as will be discussed in Step 5: Evaluation.

Intermediate outcomes reflect best practices and are linked to your process. They may be linked to the gaps in care that you have already discovered. They will have to be achieved first in order to have an impact on the ultimate outcome. Hence you will have both short term and long term objectives. These outcomes are closer to your actual practices and hence monitoring their progress can serve to motivate the practitioners/professionals. Using evidence-based interventions as targets for your practice should be a requirement.

Examples

  • Optimize pharmacological and non-pharmacological therapy (stop smoking interventions, self-management, pulmonary rehabilitation)
  • Improve the links and communication between the hospital and primary care services, including GPs

Ultimate outcome: We might be tempted to choose some outcomes such as improving patient quality of life or reducing length of stay. These are important goals; however, they represent outcomes that will only be achieved if some process outcomes are realized beforehand. On the other hand, the evaluation of these types of outcomes is particularly challenging because they may have to be measured in addition to the data that is already collected as part of your regular practice, and there are a number of factors that cannot be controlled in a real-life setting (as compared to what can be measured in a randomized clinical trial). In a similar vein, finding referent groups, or populations to compare with, can also be a problem.

Examples

  • Impact on helping patients to better cope with their disease; improve quality of life and maintain autonomy
  • Improve the efficiency of the healthcare system (ER, hospitalizations, community services, etc.)

Remember that outcomes should be SMART: Specific, Measurable, Attainable, Results-oriented, Time frames.