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Voor bijeenkomst mogelijk relevante relaties met bedrijven  Sponsoring of onderzoeksgeld  Honorarium of andere (financiële) vergoeding  Aandeelhouder  Andere relatie, namelijk …

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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


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)


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)



* Pro-active bodyscan

* Biopsy

* 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:



* Lab visits

* Lab visits

* Hospital visits

* Visits to outpatient radiation unit

* Rehabilitation facility visits


* 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 -


Thank you for your attention

Contact p:

9

+31(0)346-574942 | e: [email protected] | www.vbhc.eu

Disclosure belangen spreker

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