Samen Waarde Creëren. Jan A Hazelzet, MD PhD. CMIO and Professor Health Care Quality & Outcome

Transcription

1 Samen Waarde Creëren Jan A Hazelzet, MD PhD CMIO and Professor Health Care Quality & Outcome

2 Van: What s the matter, naar: What matters to you. Jan A Hazelzet, MD PhD CMIO and Professor Health Care Quality & Outcome

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6 These are our aims! More information: Ambition 1: Continually adding Value Our guiding principle for research, education, and health care is creating added value for patients Understanding the health, diseases, and wishes of patients Personalized medicine (individualized treatment) Prevention Translating knowledge into useful, innovative products and health care concepts

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8 Healthcare: Rapidly Increasing Complexity Diagnostic and treatment options are expanding and changing Chronic diseases and comorbid conditions are increasing Overtreatment / under treatment / unwarranted variation in outcome Care delivery has become increasingly fragmented Health care quality, and outcomes fall short of their potential Growth rate of health care expenditures is unsustainable Not patient centered Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. IOM

9 KPMG rapport: Inzicht in uitgevraagde variabelen voor kwaliteitsmetingen. Juni 2016

10 Performance

11 JAMA Internal Medicine Published online October 17, 2016

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14 VBHC: value based healthcare Health Care Quality: Effective Patient centered Safe Efficient Timely Equitable Outcomes that matter to patients Cost of achieving 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

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16 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

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18 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

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

20 Results are discussed in the consultation room

21 Diagnoses VBHC in Erasmus MC 1 st Half nd Half st Half 2017 Set Outcome Measures defined Set Outcome Measures in development Planned to start Brain Tumors Frail Elderly NeMo (neurom. & mitoch. afw) Bladder Cancer Familiar hypercholesterolemia Multiple sclerosis Stroke Cervix Cancer Palliative Care Breast Cancer Pediatric Brain Tumor Hemophilia Turner Syndrome Obstruction icterus Auto-immune Diseases Sickle cell Pregnancy & Child Birth Hemifacial Microsomia Larynx Cancer Head and Neck Tumors Congenital Cardiac Anomalies Cleft Lip Palate Liver Insufficiency IBD Prostate Cancer Peripheral Vascular Disease Hip & Knee Replacement Lung Cancer Macula Degeneration Obesity Pediatric Cardio Thoracic Surgery Kidney Transplantation Liver Cancer Colorectal Cancer Alzheimer s Disease Cataract

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23 ICHOM Set Heart Failure

24 Patiënt Gerichtheid Bastemeijer et al. PEC 2016

25 NRC

26 Kon. JAMA, 2010; 304:903 Hoffmann. JAMA 2014; 312: 1295

27 Gainer et al. Med Decis Making Nov 1

28 Gainer et al. Med Decis Making Nov 1

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30 Lytvyn L, et al. BMJ Open 2016;6:e

31 JAMA Cardiology 2016: 1: 9

32 Patient health outcome goals (care preferences) JAMA Cardiology 2016: 1: 9

33 Zhang et al. Patient Educ Couns Aug;98(8):927-34

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35 Team-Based Care JAMA August 23/30, 2016 Volume 316, Number

36 Lane et al. Europace Dec;17(12):

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39 Team based Appoint a clinical leader Clarify all responsibilities Task diversity Set common / individual goals Encourage open communication Be willing to help others, admitting mistakes & limitations Patient centered Redesign

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

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43 Circulation. 2016;134; September 13

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