Expedited patient-centered outcome measurement development for cancer care

Expedited patient-centered outcome measurement development for cancer care

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  Expedited Patient-Centered Outcome Measurement Developmentfor Cancer Care October 15, 2015 Tracy Spinks, Program Director, Cancer Care Delivery and Associate, Institute forCancer Care Innovation
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  Abstract Authors • TracyE. Spinks, Program Director, Cancer Care Delivery,The University ofTexas MD Anderson Cancer Center • Tinisha L. Mayo, Program Manager,The University ofTexas MD Anderson Cancer Center • Seohyun Lee, Graduate Research Assistant, The University ofTexas MD Anderson Cancer Center • ThomasW. Feeley, M.D., Head, Institute forCancer Care Innovation, The University ofTexas MD Anderson Cancer Center
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  About MD Anderson •Founded in 1941 • Part ofThe University ofTexas System • National Cancer Institute-designated Comprehensive CancerCenter since 1971 • Multidisciplinary care since 1992
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  MD Anderson FY2014Activity Workforce Employees Faculty Volunteers Trainees Clinical Activity Number of patients 127,000 Number of hospital beds 654 Outpatient clinic visits, treatments & procedures 1.36 MM Financial Activity in USD Revenue $4.4 BB Research expenditures $736 MM Uncompensated care $196 MM
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  About the Institutefor Cancer Care Innovation • Created in 2008 • Studies new and existing models of cancer care delivery and reimbursement, based on the principles of value-based health care delivery Research Priorities
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  BACKGROUND
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  Background • Problem: providers,payers, and patients lack timely and relevant outcomes information to: – Support informed decision-making – Make comparisons across providers and over time • Intervention: develop patient-centered outcome measures – Integrate data collection within new EPIC electronic health record (EHR)
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  Project Aims • Applyan expedited, patient- centered approach to create disease-specific outcome measure sets for cancer care • Establish routine outcomes data collection, including patient-reported outcomes (PRO), in the EHR Disease- Specific Outcomes MeasureSet Patient- Identified Outcomes (Focus Groups) Provider- Identified Outcomes (Interviews)
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  METHODS
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  Michael Porter’s OutcomeMeasures Hierarchy SOURCE Porter, M. E. (2010). What is value in health care? N Engl J Med, 363(26), 2477-2481. doi: 10.1056/NEJMp1011024.
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  Outcome Measure DevelopmentConsiderations • More measures <> better care • Fewer, high-level measures • Ideally, 5-10 outcomes per disease site, including PROs Important to Patients/ High-Impact Actionableby Clinicians Validated/ Evidence-Based Feasible Measure Criteria
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  Outcome Measure DevelopmentProcess • Measure set scope • Outcome concepts • Preliminary benchmarks ConceptDevelopment 1month MeasureSpecification 1-2months • Detailed specifications • Data sources • Data collection  Clinical workflow  Patient flow • Reporting mechanisms • Internal validation • Build design/testing/ implementation  Interim system  EHR (EPIC) • Reporting design/ implementation MeasureImplementation 6-12months Incorporate patient perspective, where possible
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  RESULTS
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  • 6 outcomesets developed within 4-6 months – 4 outcome sets deployed with new EHR (March 2016) • By late-2016, 21 outcome sets in EHR Results 6 Completed Outcome Sets  Breast  Colorectal  Head and Neck  Lung (note)  Pancreas  Prostate (note) NOTE We incorporated measure concepts developed by ICHOM for early-stage prostate cancer and lung cancer into our outcome sets.
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  Sample Outcome Set—Headand Neck SOURCE Adapted from Porter, M. E. (2010). What is value in health care? N EnglJ Med, 363(26), 2477- 2481. doi: 10.1056/NEJMp1011024. Recurrences Care-induced Illnesses Timely access, treatment start/completion Reoperation Length of stay Unplanned admission Mortality Emergency visit Tier 2 Process of Recovery Overall survival Return to work/daily activities Speaking, swallowing Tier 1 Health status achieved or retained PROs Disease-free/disease-specific survival Recurrence Dry mouth Feeding or breathing tube Cosmetic satisfaction Tier 3 Sustainability of health PROs
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  DISCUSSION
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  Discussion • Patient-centered outcomescan be developed using an expedite timeline • Provider/leadership buy-in and strong project management are essential • Short-term IT solutions can expedite progress
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  Acknowledgements • MD AndersonCancer Center: Business AffairsAdministration; Clinical Operations; Digital Experience; EHRAnalytics & Reporting; Finance; Government Relations; Head and Neck Center; Institute for Cancer Care Innovation; Office of the EVP/Physician-in-Chief • Harvard Business School Institute for Strategy and Competitiveness
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  ThankYou Contact Information Tracy Spinks,Program Director, Cancer Care Delivery [email protected] Tinisha Mayo, Program Manager, Clinical Operations [email protected] Seohyun Lee, Graduate Research Assistant [email protected] Thomas W. Feeley, M.D., Head, Institute for Cancer Care Innovation [email protected]