Before measuring outcomes it is important to determine what change you would like to see in the patient as a result of training. For example, following receipt of discharge instructions patients leaving the ambulatory surgery unit should be able to: (1) Identify the phone number for follow-up questions and appointment; and (2) State when to call for follow-up appointment. These "immediate" outcomes can be measured during or promptly after the intervention. The nurse or caregiver responsible for providing the education is usually the person responsible for recording whether the outcomes were achieved prior to the patient's discharge.

As providers merge into healthcare networks, there is a growing need to evaluate the long-term effect of patient education programs. Before studying the long-term impact, you must first select the "end-points" that will be measured. Are you going to measure the family's ability to recognize early deterioration in the patient's condition? The patient’s ability to tolerate medication side effects? Patient adherence to treatment regiments and/or lifestyle recommendations? The number of physician visits/telephone contacts made by the patient? The patient's use of coping strategies? The almost limitless number of end-point outcomes that could be measured fall into four categories: clinical, quality of life, satisfaction, and cost.

The impact of patient education on clinical outcomes can be measured in a number of ways. Educational interventions can improve patients' compliance with their medication regimen and medical follow-up care. Clinical outcomes can also be enhanced by improving the quality of the physician-patient interaction. When patients learn how to have a meaningful discussion with their physician, they are more likely to provide timely reports of their illness symptoms or adverse reactions. This minimizes the likelihood that the patient will discontinue therapy without first contacting their physician. Clinical outcomes can also improve significantly when the quality of patient self-care improves. Lifestyle management plays an important role in reducing risk in conditions such as cardiovascular disease and in improving treatment of conditions like congestive heart failure.

Health-related quality of life measures generally address patients' perceptions of their physical functioning, social functioning, role functioning, mental health, vitality, pain, and cognitive functioning. In many cases improvements in health-related quality of life are a natural result of improved clinical outcomes. However, patients' perception of their quality of life is also improved when they are empowered by well-designed educational programs. Empowered patients tend to feel more personally capable of positively impacting their outcomes. For patients with chronic conditions, health-related quality of life can improve significantly when they are trained in self-management techniques and empowered with education.

A patient’s satisfaction with his or her healthcare depends, to a great extent, on their relationship with the health care provider. The foundation of this relationship is communication between parties. Studies have shown that patients who perceive themselves as being well educated by their physician or another health care professional are more likely to be satisfied with their health care experience.

Health care costs have been shown to be reduced by education interventions that decrease the patient’s demands on the health care system. Two of the most frequently cited benefits of work-site health-promotion programs are reduced absenteeism and lost workdays. According to some estimates, approximately 80 percent of all health problems could be treated at home. Effective education programs can prevent minor illness or injury from progressing to the point of needing professional intervention. Increased patient awareness through education can also result in earlier detection of problems and more timely outpatient intervention, thus decreasing hospitalizations. Lastly, chronic-disease patients who have been empowered through patient education programs generally have better coping skills and are usually less reliant on health caregivers.

Health care professionals have long been involved in educating patients and their families. To prove the value of this education, the long-term effects must be measured. Properly designed and conducted patient education programs can demonstrate their value. Ongoing evaluation of the impact of these programs is critical to their development and overall success.

Copyright 2001 by Brown-Spath & Associates

To Learn More: Patrice L. Spath is available for inhouse presentations on this and other health care quality and resource management topics. For further details, visit Brown-Spath & Associates on the web at: http://www.brownspath.com or write to: Brown-Spath & Associates, PO Box 721, Forest Grove, OR 97116.

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