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Fayanju OM, Mayo TL, Spinks TE, Lee S, Barcenas CH, Smith BD, Giordano SH, Hwang RF, Ehlers RA, Selber JC, Walters R, Tripathy D, Hunt KK, Buchholz TA, Feeley TW, Kuerer HM. Value-Based Breast Cancer Care: A Multidisciplinary Approach for Defining Patient-Centered Outcomes. Ann Surg Oncol 2016; 23:2385-90. [PMID: 26979306 DOI: 10.1245/s10434-016-5184-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Value in healthcare-i.e., patient-centered outcomes achieved per healthcare dollar spent-can define quality and unify performance improvement goals with health outcomes of importance to patients across the entire cycle of care. We describe the process through which value-based measures for breast cancer patients and dynamic capture of these metrics via our new electronic health record (EHR) were developed at our institution. METHODS Contemporary breast cancer literature on treatment options, expected outcomes, and potential complications was extensively reviewed. Patient perspective was obtained via focus groups. Multidisciplinary physician teams met to inform a 3-phase process of (1) concept development, (2) measure specification, and (3) implementation via EHR integration. RESULTS Outcomes were divided into 3 tiers that reflect the entire cycle of care: (1) health status achieved, (2) process of recovery, and (3) sustainability of health. Within these tiers, 22 patient-centered outcomes were defined with inclusion/exclusion criteria and specifications for reporting. Patient data sources will include the Epic Systems EHR and validated patient-reported outcome questionnaires administered via our institution's patient portal. CONCLUSIONS As healthcare costs continue to rise in the United States and around the world, a value-based approach with explicit, transparently reported patient outcomes will not only create opportunities for performance improvement but will also enable benchmarking across providers, healthcare systems, and even countries. Similar value-based breast cancer care frameworks are also being pursued internationally.
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Affiliation(s)
- Oluwadamilola M Fayanju
- Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tinisha L Mayo
- Office of the Senior Vice President (SVP), Hospital and Clinics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tracy E Spinks
- Office of the Senior Vice President (SVP), Hospital and Clinics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Seohyun Lee
- The Institute for Cancer Care Innovation (ICCI), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos H Barcenas
- Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Benjamin D Smith
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Health Services Research, Division of the Office of the Vice President (OVP), Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sharon H Giordano
- Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Health Services Research, Division of the Office of the Vice President (OVP), Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rosa F Hwang
- Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard A Ehlers
- Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jesse C Selber
- Department of Plastic Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ronald Walters
- Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Office of the Executive Vice President (EVP) and Physician-in-Chief, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Debu Tripathy
- Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas A Buchholz
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Office of the Executive Vice President (EVP) and Physician-in-Chief, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas W Feeley
- The Institute for Cancer Care Innovation (ICCI), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,The Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA
| | - Henry M Kuerer
- Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Office of the Senior Vice President (SVP), Hospital and Clinics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Middleton LP, Mayo TL, Spinks TE, Cheney R, Chu P, Cooper HS, Dintzis S, Ehya H, Fletcher CD, Gerwirtz A, Magliocco AM, Martin SE, Rosenberg AE, Sherrod A, Tan LK, Wood BL, Walters RS. The value of secondary pathology review. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.7_suppl.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6 Background: Improving the value of cancer care is a major focus for the Alliance of Dedicated Cancer Centers (ADCC). Looking to align with the Institute of Medicine’s (IOM) initiative to “Develop and deploy approaches to identify, learn from, and reduce diagnostic errors and near misses in clinical practice,” the ADCC implemented a study to examine the clinical impact of expert secondary pathology review. The goal of this project was to: 1) demonstrate the value of secondary review of outside pathological specimens by ADCC subspecialty pathologists in identifying significant errors that can potentially impact treatment; and 2) create an opportunity to improve patient cancer care. Methods: All consult slides from patients referred to each ADCC center were reviewed by designated pathologists. Patient-level data for original and revised diagnoses were collected for two months in 2014. Discrepancies were classified as: 1) major - diagnosis changes treatment or surveillance; or, 2) minor - diagnosis does not change affect treatment or surveillance. To verify these assessments, disease-specific, multi-center teams of clinical experts reviewed each discrepant case and provided treatment recommendations for the original and revised diagnoses. Results: A total of 13,109 cases were collected across all ADCC centers and the discrepancy rate was 11% (1,488/1309); 3% (359/13,109) were major and 9% (1,129/13,109) were minor. The most common discrepancy was reclassification of the neoplasm cell type. The highest discrepancy rate was shown in the neuro-oncology and head and neck cases, with a 7% and 4% major discrepancy rate respectively. Conclusions: We identified an overall discrepancy rate of 11%, with 3% of cases leading to a change in treatment or surveillance. This demonstrates the importance of expert pathology review and that secondary pathology review can significantly improve clinical outcomes through precise and accurate pathological diagnoses. As indicated in the recent IOM report, this project further demonstrates that “diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions.”
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Affiliation(s)
| | - Tinisha L. Mayo
- Office of the Senior Vice President (SVP), Hospital and Clinics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tracy E. Spinks
- Office of the Senior Vice President (SVP), Hospital and Clinics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | | | - Sue Ellen Martin
- University of Southern California Medical Center, Los Angeles, CA
| | | | - Andy Sherrod
- University of Southern California, Los Angeles, CA
| | - Lee K Tan
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brent L. Wood
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Ronald Stewart Walters
- Office of the Executive Vice President (EVP) and Physician-in-Chief, The University of Texas MD Anderson Cancer Center, Houston, TX
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Fayanju OM, Mayo TL, Spinks TE, Lee S, Barcenas CH, Smith BD, Giordano SH, Hwang RF, Ehlers RA, Selber JC, Walters RS, Tripathy D, Hunt K, Buchholz TA, Feeley TW, Kuerer HM. Implementing value-based cancer care: A multidisciplinary approach to defining breast cancer outcomes. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.7_suppl.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
16 Background: Value in healthcare (patient-centered outcomes achieved per dollar spent) unifies performance improvement goals with health outcomes of importance to patients. We describe the process through which value-based measures for breast cancer patients and dynamic capture of these metrics via our new electronic health record (EHR) were developed at our institution. Methods: A review of the breast cancer literature was conducted on treatment options as well as expected outcomes and potential treatment complications. Patient perspective was obtained via focus groups. Multidisciplinary teams met to inform a 3-phase process of (1) concept development, (2) measure specification, and (3) implementation via EHR integration, planned for spring 2016. Results: Outcomes were divided into 3 previously defined tiers (NEJM 2010; 363:2477-2481) that reflect the entire cycle of care (Table).Within these tiers, 22 patient-centered outcomes were defined with inclusion/exclusion criteria, specifications for reporting, and sources for data including the EHR and validated patient-reported outcome questionnaires (e.g., FACT-B+4) administered via our patient portal. Conclusions: A value-based approach to cancer care with transparently reported patient outcomes not only creates opportunity for performance improvement but also enables benchmarking within and across providers, healthcare systems, and even countries. Our value-based framework for breast cancer is the first of its kind in the United States, with a similar model being pursued internationally as well. [Table: see text]
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Affiliation(s)
- Oluwadamilola M. Fayanju
- Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tinisha L. Mayo
- Office of the Senior Vice President (SVP), Hospital and Clinics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tracy E. Spinks
- Office of the Senior Vice President (SVP), Hospital and Clinics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Seohyun Lee
- The Institute for Cancer Care Innovation (ICCI), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carlos Hernando Barcenas
- Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Benjamin D. Smith
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sharon Hermes Giordano
- Department of Health Services Research, Division of the Office of the Vice President (OVP), Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rosa F. Hwang
- Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard A. Ehlers
- Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Nassau Bay, TX
| | - Jesse C. Selber
- Department of Plastic Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ronald Stewart Walters
- Office of the Executive Vice President (EVP) and Physician-in-Chief, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Debu Tripathy
- Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kelly Hunt
- Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Thomas A. Buchholz
- Office of the Executive Vice President (EVP) and Physician-in-Chief, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Thomas W. Feeley
- The Institute for Cancer Care Innovation (ICCI), The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Henry Mark Kuerer
- Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
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