Disclosure belangen spreker
(potentiële)
belangenverstrengeling
Voor bijeenkomst mogelijk
relevante relaties met bedrijven
 Sponsoring of onderzoeksgeld
 Honorarium of andere
(financiële) vergoeding
 Aandeelhouder
 Andere relatie, namelijk …
Geen / Zie hieronder
Bedrijfsnamen
The Decision Group/ The
Decision Institute als
adviseur met name qua
methodiek bij de uitvoering
betrokken.
Betrokken als voorzitter en
secretaris van medical en
methodological academic
council bij internationale
validatie
1 Zorg voor Uitkomst | Value Based Healthcare| February 7 2014| © 2014 The Decision Group, All rights reserved | Value Based Healthcare Center Europe, www.vbhc.eu
Zorg voor
Uitkomst
Value based
healthcare
2
Woorden van waardering van de
International Academic Council
“This has been an
extremely positive
process. This project
will have significant
benefit to the Dutch
healthcare system”
prof. dr. Peter
Goldstraw (Royal
Brompton Hospital,
London)
3 Zorg voor Uitkomst | Value Based Healthcare| February 7 2014| © 2014 The Decision Group, All rights reserved | Value Based Healthcare Center Europe, www.vbhc.eu
Council advies voor de toekomst
Het innoveren en verbeteren van de uitkomstindicatoren is
noodzakelijk, vooral in de oncologie.
Medisch
Diagnostisch
Organisatorisch
1. Multidisciplinaire
bespreking van
patiënten
1. Hoe beïnvloedt
vroege en snelle
diagnostiek
uitkomsten en
behandeling
1. Waarborging van arts
gedreven, patiënt
gerichte aanpak
2. Shared decision
making, MDT en
patiënt beslissen over
behandeling
2. Gescheiden
dataregistratie en
controle
3. Data eigenaarschap ligt
bij artsen
4. Toezicht vanuit statistici
en methodologische,
health administrative en
medische experts
4 Zorg voor Uitkomst | Value Based Healthcare| February 7 2014| © 2014 The Decision Group, All rights reserved | Value Based Healthcare Center Europe, www.vbhc.eu
Het interpreteren en leren van uitkomstindicatoren
“There will be a shift towards less under- and less overtreatment. The
Netherlands with respect to this regimen are currently far ahead of for
example Spain, Poland or Belgium”
prof. Bertrand Tombal, MD PhD (Cliniques Universitaires Saint Luc, Brussel)
5 Zorg voor Uitkomst | Value Based Healthcare| February 7 2014| © 2014 The Decision Group, All rights reserved | Value Based Healthcare Center Europe, www.vbhc.eu
Methodologie voor uitkomstindicator ontwikkeling
De definitie van de medische conditie vormt de basis voor verantwoorde
uitkomstindicatoren selectie
Care Delivery Value Chain voor primaire behandeling van prostaatkanker
* Advice on self screening
INFORMING AND
ENGAGING
* Explaining patient treatment options/
* Counseling on the treatment process
* Counseling on rehabilitation options,
* Counseling on long term risk
* Consultation on risk factors
diagnostic process and the diagnoses
shared decision making
* Patient and family psychological
process
management
* Genetic counseling
* Brochure KWF
* Counseling on sexual consequences
counseling
* Psychological counseling
* Informing on diagnostic procedures
* Counseling patient and family on the
* Brochure on disease
* Counseling on incontence consequences
* Brochures on diagnostic procedures
* Patient and family psychological
* Brochure on side effects
counseling
* Brochure on treatment
* Rectal examination score
* Side effects measurement
* Labs
* PSA
* Ultrasound (TRUS)
* Labs
* Physical QoL (Last meter)
* Physical QoL (Last meter)
* Physical QoL (Last meter)
* Pro-active bodyscan
* Biopsy
* Nutrition score (MUST or SNACK)
* Nutrition score (MUST or SNACK)
* Nutrition score (MUST or SNACK)
* Genotyping
* Rectal examination score
* MRI
* ASA score
* Comorbidity score
* Intervention-specific measurements
* Pain score
* Pain score
* Office visits (outpatient)
* Hospital stays
* CT scan
1. Medische conditie
* Bone scans
MEASURING
* PCA3 test
* PSA score
* Gleason score
* d'Amico score
* GP visits
* Office visits (outpatient)
ACCESSING
Chain link:
* Office visits (outpatient)
* Office visits (outpatient)
* Lab visits
* Lab visits
* Hospital visits
* Visits to outpatient radiation unit
* Rehabilitation facility visits
* Office visits (outpatient)
* High risk clinic visits
* Lab visits
* Pharmacy
* Pharmacy
Geneticist
1. MONITORING/PREVENTING
2. DIAGNOSING
4. INTERVENING (initial)
5. RECOVERING/REHABING
6. MONITORING/MANAGING
* Anamnesis
* Choosing treatment modality (chemotherapy, RT, Surgery)
* Radical prostatectomy; or
* Treatment of side effects (e.g. skin
* Determining specific nature of disease
* Choosing a treatment plan (timeline, dosage, ...)
* Brachy therapy; or
damage, complications, nausea, lymphodema* Treatment for any continued or later
* Surgery preparation
* External beam radiation therapy or
and chronic fatigue)
* Clinical exams (blood sample, bodyscan) (pathology, biopsy results, TNM-stage)
CARE DELIVERY
ACTIVITIES
3. PREPARING
* Medical + family history
* Control of risk factors
* Genetic screening
Patient
Value
Provider
Margin
* Follow -up clinical exams
onset side effects or complications
* Medical + family history
(anesthetic risk assessment, shaving, medication, nutrition)
* Internal radiation therapy
* In-hospital and outpatient w ound healing * Adjuvant therapy
* Formulate treatment options
* Chemotherapy preparation (medication, nutrition,..)
* Hormonal therapy
* Physical therapy
* RT preparation (medication, ...)
* Other therapy (....)
* Follow -up visit
(hormonal medication, radiation, salvage)
* Neo-adjuvant hormonal therapy
* Optimalisation of patient condition (nutrition, sports,...)
*
* Diagnosing can either result in continuation to steps 3. Preparing and 4. Intervening, or in the reloop to step 1 (active surveillance)
Feedback naar monitoring na behandeling?
Medical Specialist
In hospital - no medical specialist or not per se Other provider entity
*
2. Care Delivery Value
Chain
3.
Uitkomstindicatoren
& Initiële patiënt
condities
•6
6 Zorg voor Uitkomst | Value Based Healthcare| February 7 2014| © 2014 The Decision Group, All rights reserved | Value Based Healthcare Center Europe, www.vbhc.eu
Een historisch woud van indicatoren
Verschillende indicatoren voor verschillende beslissers en gebruikers is
de uitdaging.
“It is important to improve the healthcare system by measuring
variables. This project really measures the variables that are relevant
for the quality of work. The project is a great example of how to build a
system for outcome measurement”
prof. dr. Harry Groen (UMCG, Groningen)
7 Zorg voor Uitkomst | Value Based Healthcare| February 7 2014| © 2014 The Decision Group, All rights reserved | Value Based Healthcare Center Europe, www.vbhc.eu
Value Based Healthcare:
Arts Gedreven & Patiënt Gericht
Countries in the
VBHC network
Number of
individual
heatlthcare experts
and academics per
continent
0-10 10- 25- 50+
50
25
Academic
partners and
Cooperations
Top clinical hospitals
(Outside The
Netherlands)
- Key academic
partners -
8 Zorg voor Uitkomst | Value Based Healthcare| February 7 2014| © 2014 The Decision Group, All rights reserved | Value Based Healthcare Center Europe, www.vbhc.eu
Thank you for your attention
Contact
p:
9
+31(0)346-574942 | e: info@thedecisiongroup.nl | www.vbhc.eu