What do Fortis Healthcare in India, Karolinska in Sweden and Boston Children’s Hospital in the USA have in common with Dutch hospitals like the Erasmus Medical Center in Rotterdam and the Martini Hospital in Groningen? All of these hospitals believe in Value-Based Healthcare and partner with the International Consortium for Health Outcome Improvement (ICHOM). But to what extent do the principles of Value-Based Healthcare contribute to creating value for the patient?
ICHOM was founded several years ago by multiple parties, among which is the Harvard Business School (Michael Porter) and they are committed to the development of ‘standard sets’: standardized and validated questionnaires that can be submitted to patients and health care professionals to measure treatment outcomes. These standard sets are developed per disease, such as prostate cancer, dementia or lower back pain.
Of course this is a beautiful initiative. Its’s a novel idea to measure the ‘real’ value of treatments systematically, based on outcomes as experienced by the patient. Hospitals show significant differences in outcomes. For example, someone being treated for prostate cancer at the Martini Klinik in Hamburg – a hospital specialized in the treatment of men with prostate cancer – has a 6.5% chance to suffer from incontinence a year after the treatment, versus a 43.3% at an average German hospital. How? Martini has measured and valued outcomes for years and has been using them to continuously learn and to improve care. This has led to a refined treatment process that minimalizes the risks of negative side effects. And that is good news for patients.
But as always, as soon as something becomes a goal in itself, it loses its added value easily. This applies to every best practice, and especially to ‘patient-reported outcome measures’ (PROs). It only makes sense to measure outcomes if the results are actually applied to future care. Measuring on itself does not make any sense. We must measure to learn.
Easier said than done, how does this work in practice? Experiences show that it works best when PROs are being used to support the patient-doctor conversation. The doctor can use the questionnaire and average outcomes to discuss the several treatment options and their pros and cons. Patients are enabled to make well-informed treatment choices, together with their doctors: ‘shared decision making’.
In addition, when a patient can rely on the actual usage of the results, he or she is more motivated to fill out the questionnaires: for example, when the doctor uses the filled out questionnaires at a doctor’s routine check after treatment. The patient can use the completion of the questionnaire as a structured way of preparing the consultation.
How do we ensure that doctors make time to work with the questionnaires, and take them seriously, instead of experiencing them like a time-consuming duty for registration? It’s important the PROs are integrated in the EHR, so it fits seamlessly into the workflow. In addition, it’s important that the outcomes are being saved structurally and automatically in the EHR and that the practitioner receives convenient ‘population dashboards’ that will give insight in the outcomes of a population of patients.
In short, the systematic evaluation using patient-reported outcomes is useful, but its implementation requires diligence and thoroughness. We can give meaning to the outcomes by sharing knowledge and experience. This way, we ensure that both the doctor and the patient experience the added value and discover that it supports the treatment. This determines the difference between valueless and valuable.
Laurens van der Tang
CEO VitalHealth Software