international consortium for health outcomes measurement

International Consortium for Health Outcomes Measurement

Dr James Kent, BCGDr Tom Kelley, ICHOM

Kings Fund 18th November 2014

141118-ICHOM-Kings Fund-Final.pptx 1Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.

Evolving healthcare systems

Outcomes

focused

Accountable care

...ensuring payments are

linked to outcomes

Integrated care

...ensuring many providers

can coordinate to deliver

outcomes

Value-based health

care

...ensuring decisions are

framed as outcomes over

input costs

Bundled care

..ensuring payment covers

all aspects of care around

a procedure


Paucity of outcomes data

Where available, hard to compare

Too much time spend in 'definitions' meetings

Lack of standardisation

• Barrier to transparency

• Inability to compare and learn

• Slow pace of change

Problem


Independent, not-for-profit

Focus on standards, not collecting data

Build on the best, selecting not redefining

Focus on outcomes that matter to patients▪ 'Minimum set'

Open source

Solution


Define internationally recognized Standard Sets of outcomes

▪ Together with risk adjustment factors

Drive the adoption of Standard Sets globally

▪ Wide dissemination among clinicians and patient groups

Create global communities focused on outcome comparison

• Support learning, and practice improvement

Three objectives

1

2

3


Localized Prostate Cancer Set

Treatment approaches covered

▪ Watchful waiting▪ Active surveillance▪ Prostatectomy▪ External beam radiation therapy ▪ Brachytherapy▪ Androgen Deprivation Treatment▪ Other

Details1 Recorded via the Clavien-Dindo-Classification2 Recorded via the Common Terminology Criteria for

Adverse Events (CTCAE), version 4.0 3 Recommended to track via the Expanded Prostate

Cancer Index Composite (EPIC)-26


Prostate Cancer Working Group

Adam Glaser, St James’ Institute of Oncology; NHSJim Catto, University of Sheffield, European Urology

Kim Moretti, South Australian Prostate Cancer Clinical Outcome CollaborativeMark Frydenberg, Prostate Cancer Registry of VictoriaIan Roos*, Cancer Voices Victoria

Frank SullivanProstate Cancer InstituteJohn Fitzpatrick, Irish Cancer Society

Hartwig Huland and Markus Graefen, Martini KlinikMichael Froehner, Günter Feick*, Bundesverband Prostatakrebs Selbsthilfe (BPS); Europa UOMOThomas Wiegel, University Hospital Ulm

C.H. Bangma, Erasmus Medical Center

Anna Bill-Axelson, Swedish Prostate Cancer Registry

Francesco Montorsi, European Urology Editor in ChiefAlberto Briganti, Vita-Salute San Raffaele University Hospital, Milan

Jabob Ramon, Sheba Medical Center

Steven Jay Frank, MD AndersonDavid Swanson, MD AndersonAndrew Vickers, MSKCCAdam Kibel, Dana Farber/BWHMichael O’Leary, Dana Farber/BWHAnthony D’Amico, Dana Farber/BWHNeil Martin, Dana Farber/BWHMichael Blute, MGHHoward Sandler, Cedars-SinaiRonald Chen, University of North CarolinaDan Hamstra, University of MichiganAsh Tewari, Weill Cornell Medical College

*Patient representative


Working Group process

After outcomes and measures are defined, a similar process follows to identify and define an

accompanying set of risk factors and initial conditions


Up

for

Deb

ate

Criteria to prioritise outcomes

OutcomeFrequency

(5=high)Severity(5=high)

Avoidability(5=high)

Feasibility to capture

(5= easy)

Nerve root injury incl. cauda equina ++ ++++ +++ ++++

Deep wound infection (e.g., meningitis, discitis, osteitis) ++ +++++ +++ ++++

Pulmonary embolus + +++++ ++++ ++++

Wrong site procedure + ++++ +++++ +++++

Vascular injury + +++ +++ ++++

Dural tear/ CSF leak ++ ++ +++ +++

Wound dehiscence ++ ++ +++ ++++

Hematoma +++ ++ +++ +++

Superficial infection (cellulitis) +++ + +++ +++

Malpositioned implant ++ + +++ +++

Long OR/anesthesia time ++ + ++ ++++

Hemorrhage/blood transfusion required + + +++ ++++

Su

gg

est

Incl

ud

ing

Su

gg

est

no

t In

clu

din

g

Example: Complications after spine surgery, part of Low Back Pain Standard Set


Criteria to select PROMs

* Pubmed search on "COMI, Back Pain, 2001-2011"Note: RoM, Range of Motion; FCE, Functional Capacity Evaluation; LBPRS, LBP rating scale; PSFS, Patient-specific functional scaleSource: Chapman et al, Measuring Treatment Success for Chronic Low Back Pain, Spine 2011; Mannion et al, Outcome assessment in low back pain: how low can you go?, Eur Spine J.,2005

ODI Roland Morris

COMI

# of languages (val.transl)

14 9 9

# of items 10 24 7

Valid Yes Yes Yes

Reliable Yes Yes Yes

Responsive Yes Yes Yes

Needs license Yes (no cost)

No No

Clinicalinterpret-ability

+++ + +

200

150

100

50

0

Trunk flex

PSFSSchoberLBP-RS

FCEQuebecRoMRoland Morris

ODI COMI*

# of citations

Top 10 frequently cited measures of

function in LBP (2001-2011)

ODI short and well translated, license

grants access to high-quality

translations

Example: Selecting the best measure of disability in Low Back Pain


All Sets contain Patient Reported OutcomesS

tan

da

rd S

ets

PR

O t

oo

ls

MDS-UPDRS

NMSQuest

PDQ-8

Catquest 9SF ODI

NPS

EQ-5D

SAQ-7

PHQ-2

Rose

Cleft-Q

NOSE scale


ICHOM Sets that we are developing


Our Sets are used by 45+ institutions

Examples

▪ MD Anderson (US) – Localized Prostate Cancer

▪ Stanford University (US) – Low Back Pain

▪ The Ohio State University (US) – Low Back Pain

▪ Mayo Clinic (US) – Parkison's Disease

▪ Fortis Health Care (IN) – Coronary Artery Disease

▪ Aravind (IN) - Cataracts

▪ Martini Klinik (DE) – Localized Prostate Cancer

▪ Hamburg Brachytherapy (DE) –Localized Prostate Cancer

▪ Australian Prostate Cancer Clinical Registry (AU) – Localized Prostate Cancer


Driving adoption in the UK

Existing collaborationSupporting the development

of our Sets

National adoptionSets used by nationalmeasurement efforts

Potential Pilot SitesLeading centres working to

use our Sets


Creating communities: global network for CLP

Group of 12 hospitals formed – aim to begin collection mid 2015


Define internationally recognized Standard Sets of outcomes

▪ Building on the best

Drive the adoption of Standard Sets globally

▪ Open Source to encourage roll-out

Create global communities

▪ Driving comparison, learning, and practice improvement

Recap: three objectives

1

2

3

international consortium for health outcomes measurement

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