Measuring the value of healthcare activities. Susan Rollason, Director of Finance and Strategy

Transcription

1 Measuring the value of healthcare activities Susan Rollason, Director of Finance and Strategy

2 Items covered What are we doing and why? What have we done so far? What challenges have we faced?

3 What are we doing? The Trust s Service Line Reporting (SLR) work programme has recently incorporated a health outcome measurement element Service Line Reporting Programme Board Technical Costing and Income Group Costing Systems Development Group Clinical Health Outcomes Dataset Development Group

4 Why are we doing this? The Trust s operation generates patient level health outcome data on a daily basis. However, relatively little focus has been placed on developing these important datasets and how they can be used to generate insight into what constitutes cost effective care. National Policy drive: Adoption of best Possible Value Framework approach System architecture: Sustainability and Transformation planning footprint Local Corporate objective: Pursuit of defining and delivering world-class services Planning and performance: Improve the sophistication of performance discussions and better clinical service line planning. To aid investment decisions: Allocative as well as technical efficiency focus.

5 Establishing a clinical service line to work with Why Prostate Cancer? Proactive and engaging Consultant and Nursing body. Various treatment options with multispecialty input, requires us to view the service line from a patient perspective, as opposed to the traditional SLR specialty service line construct. The pathway is mostly delivered within an acute setting. Prostate cancer care recently subject to significant capital development. An interesting case study from the perspective of using the rich patient level datasets that currently exist for cancer care. Significant challenge in the 62 day delivery target Large proportion of cancer pathways

6 Using data to understand where variation in clinical practice exists

7 theatre mins Surgical treatment path Our PLICs model provides us with pretty good data to help assess variation against the traditional set of input/process metrics of. Length of stay very little variation. Major Robotic Prostate or Bladder Neck Procedures (Male) - - Total time in theatre (mins) Major Robotic Prostate or Bladder Neck Procedures (Male) - Total length of stay Major Robotic Prostate or Bladder Neck Procedures (Male) (n=151) (Outlier n=1 ; 0.7%) Time in theatre very little variation, with 1 outlier in the sample.

8 Fractions Radiotherapy treatment path Fractionation rates potential to change clinical practice?... Radiotherapy fractionation per patient % (n.82) of patients receiving more than 20 fractions. Cost differential of 2,380 per patient patient

9 What have we spent on treating prostate cancer in ? Excludes activity and cost relating to outpatients and biopsy related work.

10 So what?

11 survival rate (%) incidence (%) incidence (%) survival rate (%) Prostate Cancer survival rates vs. quality of life - where do we direct our resources?... Age standardised 1-year relative survival for Prostate Cancer Collecting patient level quality of life datasets will provide us with the means to broaden the decision making context, when it comes to investing in Prostate Cancer care Northern Europe Ireland and UK Central Europe Southern Europe 98.0 Eastern Europe Incidence of 1 year incontinance 2 Incidence of 1 year severe erectile dysfunction Germany Sweden Germany Sweden Best-in-class: Martini Klinik Germany Sweden Best-in-class: Martini Klinik 1 Trama et al. (2015). Survival of male genital cancers (prostate, testis, and penis) in Europe : Research from the EUROCARE-5 Study. European Journal of Cancer, Volume 51 (15), pp Drawn from International Consortium for Health Outcomes Measurement (ICHOM) presentation to Healthcare Finance Management Association (HFMA). Thom Kelly, 12 October, 2016.

12 Measuring the value of Prostate Cancer care Our journey

13 What have we done so far? An overview of the work that we have done and/or planning to do Taken a strategic decision to link our health outcome measurement development work to the ICHOM programme; Established a service line to work with; and Progressing work within a two stage approach to developing and using health outcome data: Stage I: a) Data collection/development; b) Data synthesis; c) Statistical reporting Stage II: Deploy the better value decision making framework for the service line in question

14 International Consortium for Health Outcomes Measurement (ICHOM) Mature stage of development Standard sets developed for 50% of global disease burden by end of Global collaboration Facilitating the comparison of performance to other providers/systems across the world. Clinically led Why ICHOM? Instant recognition and buy-in from Clinical colleagues. Standard set guidance material is intuitive, clear and transparent Avoiding the need for work-arounds and duplication of effort. Objectives Define internationally recognized Standard Sets of outcomes Together with risk adjustment factors Drive the adoption of Standard Sets globally Wide dissemination among clinicians and patient groups Create global communities focused on outcome comparison Support learning, and practice improvement

15 Following the ICHOM journey for Prostate Cancer Engage the organisation UHCW Cancer Board Clinical support from Urological Surgeon and Cancer Team Set up data collection Project team established Starting point assessed Developing appropriate tools to capture data Measure and analyse Develop data quality Develop robust data linkage methodology Develop reporting suite Drive change Report data Act on data Disseminate best practice

16 Developing health outcome data held by the Trust Theme Objective Data collection/reporting Map current data items to IHCOM standard set reference guide, to assess any gaps. Improve the efficiency of current data collection processes. Initiate a data collection process for ICHOM data not currently collected. Data synthesis Establish a methodology by which to link health outcome data to the right patient and the right health care activity. Quality assure costing apportionment methodology to activity across the pathway. Statistical reporting Create a robust statistical treatment approach of linked costed health activity data and patient level outcome data, to test association.

17 Understanding what data we currently collect IHCOM Standard Set Reference Guide Localised and Advanced Prostate Cancer Casemix variables Patient factors Baseline tumour factors Pathology Treatment variables Surveillance Surgery Radiotherapy Chemotherapy Outcomes Acute complications of treatment Survival and disease control Patient reported health status/degree of health Whilst we collect information that would give us the data necessary to service ICHOM requirements, processes are inefficient. Data currently being collected by UHCW National Prostate Cancer Audit National Cancer Data Repository National Cancer Patient Experience Survey Patient Administration System and other activity datasets and we do not currently capture any of this

18 Improvements to data collection processes Developing a web-based form which will provide clinical staff with one place to enter relevant patient level information to meet all audit reporting requirements. Created the quality of life questionnaires so that patient reported quality of life and health status data can be collected. EORTC QLQ PR-25 survey EPIC-26 survey

19 Prostate Cancer Data Portal: one place to go to get all information relating to our prostate cancer care

20 Prostate Cancer data portal Clinical informatics Patient level Casemix & Pathology Commercial informatics Patient level Resources Treatment & Complications Activities Quality of Life & Survival Income Mosaic Somerset Cancer Registry PAS PLICS

21 Early findings and results More proactive and consistent approach to data collection. Successful engagement with patients over 650 questionnaires have been sent with a 50% return rate. Data submitted to the British Association of Urological Surgeons (BAUS): 100% of mandatory fields completed and 75% of optional data items provided in this year s return, compared to 80% and 0% last year. Cancer audits reports are no longer populated manually, which took on average 3 weeks to collate the data required. It now takes 5 minutes to generate the required reports. A bank of information on the quality of life associated with prostate cancer care is now available for us to integrate with our costing information.

22 Reporting intentions patients

23 T1/a/b/c N0 M0 G<=6 PSA<10 T1/a/b/c N0 M0 G=7 PSA<20 T1/a/b/c N0 M0 G<=6 PSA>10<1 9 T1/a/b/c N0 M0 G=any PSA>=20 T1a/b/c N0 M0 G>=8 PSA=any T2/a/b/c N0 M0 G<=6 PSA<10 T2/a/b/c N0 M0 G=7 PSA<20 T2/a/b/c N0 M0 G<=6 PSA>10<19 T2/a/b/c N0 M0 G=any PSA>=20 T2/a/b/c N0 M0 G>=8 PSA=any WELCOME TO THE PROSTATE CANCER PATIENT TOOL T3/a/b N0 M0 G=any PSA=any T4/a/b N0 M0 G=any PSA=any T=any N1 M0 G=any PSA=any T=any N=any M1 G=any PSA=any TREATMENTS PLEASE VIEW AS SLIDE SHOW VERSION 1.0: MAY 2017

24 BILATERAL ORCHIDECTOMY RADICAL PROSTATECTOMY TRANSURETHRAL RESECTION OF PROSTATE SALVAGE THERAPY ANDROGEN DEPRIVATION THERAPY CONTINUOUS ANDROGEN DEPRIVATION THERAPY INTERMITTENT BEAM RADIATION RADICAL EXTERNAL BISPHOSPHONATES OR DENOSUMAB BRACHYTHERAPY LOW DOSE RATE BRACHYTHERAPY HIGH DOSE RATE CHEMOTHERAPY CRYOTHERAPY FOCAL THERAPY (ANY MODALITY) HIGH INTENSITY FOCUSSED ULTRASOUND (HIFU) HORMONE THERAPY ADJUVANT HORMONE THERAPY NEOADJUVANT WELCOME TO THE PROSTATE CANCER TREATMENT OPTIONS PATIENT TOOL HORMONE TREATMENT OTHER THAN ADT RADIOTHERAPY IMMUNOTHERAPY ACTIVE SURVEILLANCE PALLIATIVE RADIOTHERAPY SPECIALIST PALLIATIVE CARE RADIO PHARMACETICALS WATCHFUL WAITING

25 PSA <10 Gleas on <=6 1. T1 / a / b / c M0 N0 T1: Doctor cannot feel the tumour or see it with imaging. T1a: Incidental finding, cancer is in no more than 5% of tissue removed. T1b: Incidental finding, cancer is in more than 5% of tissue removed. T1c: Tumour identified by needle biopsy because of an increased PSA. N0: Cancer has not spread to any nearby lymph nodes. M0: Cancer has not spread beyond the nearby lymph nodes. Gleason <=6: Well differentiated or low grade and the cancer is likely to be less aggressive i.e. the cancer tends to grow and spread slowly. PSA <10: Measure of Prostate Specific Antigen in blood less than 10ng/mL. Lack of energy Feeling depressed Change in body weight 80% 60% 40% 20% 0% Breast tenderness / enlargement Hot flashes Overall Quality of Life 100% Pain Performance Status Urinary problems Bowel movement problems Sexual dysfunction Cancer Age 40 Age 45 Age 50 Age 55 Age 60 Age 65 Age 70 Age 75 Age 80 Alive

26 Reporting intentions for decision makers

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29 This work will strengthen our approach to deploying the better value decision framework for prostate cancer care Linking our patient level costed health activity datasets with patient level health outcome data will put us in a place where we study: Quantifying the potential trade-off between survival rate and quality of life. Studying the relationship between cancer care access and the effect on quality of life. What type of health care inputs, at what times, have the most effect on enhancing quality of life. Better value decision making framework What 1 2 Framing your decision context, objectives and constraints using a value perspective When 4 3 Starting at the right time, with the right timetable and milestones to make considering and delivering better value possible Who Getting the right people engaged to ensure focus on system-wide value How Taking the right steps, through the right process with the right analysis for an integrated value approach

30 Challenges and issues to resolve Duplication of data collection processes Governance Capacity Complexity

31 Thank-you!