Value Based Healthcare (in Erasmus MC)

Transcription

1 Value Based Healthcare (in Erasmus MC) Jan A Hazelzet, MD PhD CMIO and Professor Health Care Quality & Outcome

2 Real World Data: How well do we perform in the real world? What is the added Value?

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4 The effect size Benefit Harm Resources necessary appropriate inappropriate futile Zero Adapted from: Gray M. How to Get Better Value Healthcare. 2nd edition. Oxford: Offox Press Ltd.; 2011

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6 VBHC: value based healthcare Health Care Quality: Effective Patient centered Safe Efficient Timely Equitable Outcomes + Experiences that matter to patients + energy needed to achieve the outcomes Focus on Disease / Individual Team based approach Care Path / Integrated Care Measurement of outcome & costs in every patient == Culture / Organizational change Fee for volume performance VALUE

7 Focus on the outcomes that matter most to patients

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9 Why PRO (patient reported outcome) Biomarkers fail to correspond with how patients actually feel Patients value biomarkers differently PROM s provide a key component to understand burden of disease Especially important in diseases with morbidity (and low mortality) Starting point for improvement of therapy Better communication and shared decision making Detecting adverse effects of therapy PRO PROM PRO-PM o Depression HADS - % pts wit initial HADS > 8, and < 8 at 6m PRO vs PRE vs Satisfaction

10 Programma Uitkomstinformatie voor Samen Beslissen Integrale en Waardegedreven Zorg

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12 Erasmus MC Blueprint Facilitate the teams on their journey towards VBHC Intake Preparation Develop & Design Building Implement Evaluate & Innovate Change management Expertise team VBHC Collab. agreement Preparation Care path & Outcome set Building IT configuration Building dashboard Facilitate benchmark Disease team Signing up Preparation Optimize path & set Implement & measure Continuous improvement Benchmark & innovate Patient participation in the sessions

13 Breast Cancer CTCAE v4.0 EORTC QLQ-C30 EORTC QLQ-C30 EORTC QLQ-BR23 FACT-ES EORTC QLQ-LMC21 EORTC QLQ-C30 BREAST-Q BREAST-Q EORTC QLQ- BR23

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16 Patient Reported Outcome Measures (PROMs) en Provider Reported Measures

17 PROM-learning 2,5 years registration (at outpatient clinic or by phone/ post) PROMs No response Reminder PROMs No response Data registration in waiting room prior to/after clinic Patient response PROMs data visible to clinican Patient reponse Including feedback by health care professional Need for normscores : What is to be expected? When to intervene?

18 Results are discussed in the consultation room PROMS domains in time

19 Hands on Prospective data: Local: Erasmus MC collection (since 2015) including feedback Regional: benchmarking with 7 regional partner hospitals o Start Summer 2018: first results Q o Data platform and dashboard: Dutch Hospital Data (DHD) National: initiative to measure PROMs in 3 other UMCs Platform DHD o Possible first results: Q International benchmarking (plans): o European University Hospital Alliance: first results Q o ICHOM / AllCan o Dana Farber Cancer Centre, Boston o OECD

20 Lagendijk, M., van Egdom, L.S.E., van Veen, F.E.E. et al. Ann Surg Oncol (2018).

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24 Cleft Lip and Palate

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29 The Timeline of VBHC in Erasmus MC Starting: Head and Neck cancer Starting: Bladder cancer Starting: Macula degeneration (T) Starting: Cataract (T) Starting: Starting: Subarachnoid hemorrhage Pregnancy & Birth Breast cancer Sickle-cell disease Craniofacial GIST Esophageal and anorectal Stroke Cervical cancer Microsomia malformations Cleft lip & palate Pediatric thoracic surgery Functional bladder *Start: Pilot Value Based Reproductive medicine: Turner syndrome Pediatric brain tumors disorders Payment (Testicular sperm extraction Brain tumors Obstructive Jaundice Larynx cancer *First VBHC course and IVF) Obesity (T) Lung cancer Peripheral vascular (Erasmus Summer School) Autoimmune inflammatory Liver tumors disease *Start: Pilot Value Based disease (incl. biologicals) Liver transplantations Skin cancer (T) Healthcare Medical Multiple myeloma Kidney transplantations Sarcoma Curriculum Congenital hand Familial hypercholesterolemia malformations 1 st Erasmus MC and ICHOM strategic partnership *HBR: A Blueprint for Measuring Health Care Outcomes Overall health *2nd VBHC course (Erasmus Summer School) = Erasmus participation in ICHOM set

30 Pregnancy and Childbirth

31 Work in Progress: Overall Health Adult Overall Health Pediatric Hand and Wrist Conditions Congenital Heart Disease Head & Neck Oncology

32 Overall Health Pediatric

33 Evidence vs Value Based Health Care JAMA 2014; 312:

34 Towards Continuous Team-based Redesign based on Value Organizational Support Change Support Performance Data Set PROM s PREM s Clinical Outcome Disease Team United, responsible, accountable Care Proposition Preventable Complications..clinical leadership, team collaboration, personal commitment Data Support Patient Support Key Process Measures Finance Team Culture

35 Ambitie: samen keren we de piramide om

36 EPD: het belang van klinische documentatie

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38 Lange Termijn Concept Documenteer eenmalig, ondubbelzinnig, in het primaire proces (EPD) Ziekte / probleem specifieke informatie Basis Gegevens set Zorg Aggregatie geanonimiseerd Derivatie etc. Meervoudig Gebruik: Zorg Informatie Uitwisseling (consent) Research Management informatie Kwaliteit Primaire proces Financieel / Bekostiging Beleid

39 VALUE BASED HEALTHCARE (VBHC) Value = Outcomes & experiences that matter to patients Costs and energy needed Focus on disease / individual Team based approach Care Path Integrated Care Shared decisionmaking Measurement of outcome & costs in patient Culture / Organizational change Fee for volume performance

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41 2019 August, every day 13-16hr