ICHOM-INTERN L CONSORTIUM ON HEALTH OUTCOMES MEASUREMENT

Transcription

1 Poster Session HRT11420 Innovation Awards November 2014 Melbourne ICHOM-INTERN L CONSORTIUM ON HEALTH OUTCOMES MEASUREMENT Jeremy Millar AlfredHealth Monash University The Health Roundtable

2 Key problem: There is enormous variation in health outcomes for patients with health problems managed even in developed countries around the world and this is enormously costly in money and happiness; and yet the human impact is poorly measured and tracked so we fail to move towards highvalue health care Aim: Align international experts on a list of outcomes domains, baseline and risk adjustment factors in order to pool de-identified patient-level data together to analyze variations What: Brought together experts in 4 common health conditions including prostate cancer to develop and promote standard data sets; pool and benchmark these; note variation and spread best practice First datasets published; developing implementation program The Health Roundtable

3 On outcomes that matter to prostate cancer patients, there is dramatic variation and strong potential for improvement % yr full continence Germany Sweden Best-in-class: Martini Klinik 1 yr urinary incontinence yr severe urinary incontinence 0.4 Swedish data rough estimates from graphs Source: National quality report for the year of diagnosis 2012 from the National Prostate Cancer Register (NPCR) Sweden, Martini Klinik, BARMER GEK Report Krankenhaus 2012, Patient-reported outcomes (EORTC-PSM), 1 year after treatment, 2010

4 Analyzing variation globally will open greater opportunities for learning and improvement Align on standard metrics of success Align international experts on a list of outcomes domains, baseline and risk adjustment factors Provide clear and unambiguous definitions to track these standard metrics across countries and care setting Implement systematic measurement Develop guidelines and tools to facilitate the adoption of the Standard Set Identify IT solutions and develop "ready-to-use" solutions (with instruments and questionnaires ) Support centers in the adoption of the Sets Analyze global data, identify and share best practices Pool de-identified patient-level data together to analyze variations Use "Positive Deviance" methodology to understand the reasons of positive variations and best practices Pilot best practices in a few centers to establish evidence Spread the best practices

5 Systematic outcome measurement allows rapid identification and spread of best practices 6 months for full adoption of FFLU at MK The individual results of every Martini Klinik surgeon are tracked and compared to improve care early adopter 2 innovato r early adopter 1 Martini Klinik s diffusion of surgical innovation took 6 months, as compared to 15 years on average in the literature Source: Eur Urol 60 (2011): FFLU: Full Functional Length Urethra

6 Outcome comparisons globally could improve the lives of 1000s of prostate cancer patients Improving the number of patients fully continent after a year: example for the US 100,000 80,000 60,000 40,000 20,000 0 (based on 88,000 prostatectomies per year) 50, ,560 82,720 Befor Afte (57%) e (94%) r A collaborative built around outcomes measurement will allow us to identify and understand sources of variation Over time, through shared learning and knowledge exchange, we can reduce this variation and improve care for patients around the world In the United States, ~ 88,000 prostatectomies performed in 2008 If we assume that the average 1- year continence rate in the US is similar to Germany (57%), bringing the US average to the rate of Martini Klinik (94%) would mean that an additional 32,000+ American men would regain full continence

7 ICHOM built the "common language" of outcomes measurement for prostate cancer Example for Localized Prostate Cancer Treatment approaches covered Watchful waiting Active surveillance Prostatectomy External beam radiation therapy Brachytherapy Androgen Deprivation Treatment Other A "reference guide" contains all the details to measure in a standard way the outcomes recommended (link to download) 2013 ICHOM. All rights reserved. When using this set of outcomes, or quoting therefrom, in any way, we solely require that you always make a reference to ICHOM a s the source so that this organization can continue i ts work to define more standard outcome sets.

8 Several innovators are moving forward with implementation A few examples for Prostate Cancer MD Anderson (US) Dana Farber/Brigham and Women s Hospital (US) Martini Klinik (DE) Hamburg Brachytherapy (DE) Irish Prostate Cancer Outcomes Registry (IE) Australian Prostate Cancer Clinical Registry (AU) And many more have expressed interest Facilitating adoption and capturing learning at leading centers, while ramping up new contributors would accelerate the impact of outcomes

9 OUTCOMES SO FAR The Health Roundtable

10 LESSONS LEARNT Michael Porter s proposition of aligning all stakeholders on maximising value of health care, and of facilitating this by measurement of outcomes that matter to patients needs to be translated into real-word systems Datasets designed to drive institutional improvement are different from Registries designed to propel systematic changes: the first is bottom up & the 2 nd top-down Professional engagement, institutional support, and governance policy changes are all necessary for these efforts but each not sufficient to achieve change The Health Roundtable

11 A/Professor Jeremy Millar A/Professor Sue Evans The Health Roundtable