Transcript Stirling Bryan

The contribution of PROMs to
health care sustainability
Mark Harrison
Stirling Bryan
Deborah Marshall
Nick Bansback
PROMs definitions
• Patient-reported outcome measures ‘PROMs’
– Short, self-completed questionnaires
– Measure impact of illness/health condition, from
patient perspective
• Quality of life, symptom severity, functional status, health
status
– Monitor progress of condition, effectiveness of
treatment
• Change over time
– Assess quality of care/services
CIHI. PROMs Background Document. 2015. Available from:
https://www.cihi.ca/sites/default/files/document/proms_background_may21_en-web.pdf
Generic vs. Condition Specific
• Generic e.g. HUI, EQ-5D, SF- instruments
– Comparable across diseases, sectors, against norms
– Cost-effectiveness analysis
• Condition/Disease/Population specific
e.g. Oxford Knee Score, Seattle Angina Questionnaire
– Developed for a specific setting
• Sensitive to change/differences between people within
condition
– Detail & clinical decision making
Routine PROMs collection: Canada
British Columbia
PEAK Project
Knee arthroplasty (EQ-5D, SF-12)
CIHI. PROMs Background Document. 2015. Available from:
https://www.cihi.ca/sites/default/files/document/proms_background_may21_en-web.pdf
Routine PROMs collection: Canada
British Columbia
PEAK
Project
Alberta
Knee Hip
arthroplasty
(EQ-5D, SF-12)
& knee arthroplasty
(SF-36, WOMAC)
Heart & Lung Transplant Clinic
U of Alberta Hospital (HUI2, HUI3)
CIHI. PROMs Background Document. 2015. Available from:
https://www.cihi.ca/sites/default/files/document/proms_background_may21_en-web.pdf
Routine PROMs collection: Canada
British Columbia
PEAK
Project
Alberta
Knee Hip
arthroplasty
SF-12)(SF-36, WOMAC)
and knee(EQ-5D,
arthroplasty
Saskatchewan
Heart and Lung Transplant Clinic
UJoint
of A arthroplasty
Hospital (HUI2,
HUI3)
(EQ-5D)
Spinal surgery (EQ-5D)
CIHI. PROMs Background Document. 2015. Available from:
https://www.cihi.ca/sites/default/files/document/proms_background_may21_en-web.pdf
Routine PROMs collection: Canada
British Columbia
PEAK
Project
Alberta
Knee Hip
arthroplasty
SF-12)(SF-36, WOMAC)
and knee(EQ-5D,
arthroplasty
Saskatchewan
Heart and Lung Transplant Clinic
Manitoba
UJoint
of A arthroplasty
Hospital (HUI2,
HUI3)
(EQ-5D)
Joint Replacement Group
SpinalWinnipeg
surgery (EQ-5D)
(SF-12, Oxford Scores)
CIHI. PROMs Background Document. 2015. Available from:
https://www.cihi.ca/sites/default/files/document/proms_background_may21_en-web.pdf
Routine PROMs collection: Canada
British Columbia
PEAK
Project
Alberta
Knee Hip
arthroplasty
SF-12)(SF-36, WOMAC)
and knee(EQ-5D,
arthroplasty
Saskatchewan
Heart and Lung Transplant Clinic
Manitoba
UJoint
of A arthroplasty
Hospital (HUI2,
HUI3)
(EQ-5D)
Joint Replacement Group
SpinalWinnipeg
surgery (EQ-5D)
Ontario
(SF-12,
Oxford
Scores)
Electronic
Rheumatology
(eRHeum) and
Initiatives Research Program (SF-36)
CIHI. PROMs Background Document. 2015. Available from:
https://www.cihi.ca/sites/default/files/document/proms_background_may21_en-web.pdf
Routine PROMs collection: Canada
British Columbia
PEAK
Project
Alberta
Knee Hip
arthroplasty
SF-12)(SF-36, WOMAC)
and knee(EQ-5D,
arthroplasty
Saskatchewan
Heart and Lung Transplant Clinic
Manitoba
UJoint
of A arthroplasty
Hospital (HUI2,
HUI3)
(EQ-5D)
Joint Replacement Group
SpinalWinnipeg
surgery (EQ-5D)
Ontario
(SF-12,
Oxford
Scores)
Electronic
Rheumatology
(eRHeum) and
Initiatives Research Program (SF-36)
National:
Rick Hansen Research Institute, Spinal Cord Injury Registry (SF-36)
Statistics Canada, Canadian Community Health Survey (HUI, RAND SF-36)
Canadian Multicentre Osteoporosis Study (HUI, SF-36)
CIHI. PROMs Background Document. 2015. Available from:
https://www.cihi.ca/sites/default/files/document/proms_background_may21_en-web.pdf
Sustainability
• Issues of health care sustainability
Sustainability
• Issues of health care sustainability
•
Sustainability
• Issues of health care sustainability
•
• How PROMs can contribute to sustainability
The wedge: unsustainable health care
“Business as usual”
“Sustainable”
(equal to growth in GDP)
From: Eliminating Waste in Health Care
JAMA. 2012;307(14):1513-1516. doi:10.1001/jama.2012.362
The wedge: sources of waste
“Business as usual”
Failure of care delivery
Failure of co-ordination
of care
Overtreatment
Administrative issues
Pricing failure
Fraud and abuse
“Sustainable”
(equal to growth in GDP)
From: Eliminating Waste in Health Care
JAMA. 2012;307(14):1513-1516. doi:10.1001/jama.2012.362
The wedge: the cheese
“Business as usual”
Care delivery failure
Poor co-ordination
Overtreatment
Administrative issues
Pricing failure
Fraud and abuse
“Sustainable”
(equal to growth in GDP)
From: Eliminating Waste in Health Care
JAMA. 2012;307(14):1513-1516. doi:10.1001/jama.2012.362
The potential of PROMs to improve
efficiency
Roles for routinely collected PROMs
• Allocative efficiency
• Which treatments to offer and to who
• Which treatment is best for a given patient
• Technical efficiency
• Performance
• Comparison of performance
• Accountability
• Are health resources being spent wisely
• Health system level performance
Smith & Street. Health Econ. 22: 119-131 (2013)
Stirling Bryan
PROMs:
from technology appraisal to
technology management
Deborah Marshall
PROMs as an outcome for
continuous quality improvement
Nick Bansback
PROMs to support informed
patient decision-making
Format
• 3 presentations of 15 mins
• 5 mins for questions after each presentation
• Open discussion
Disclosures
Nothing relevant
• I hold the UBC Professorship in Sustainable Health
Care, which is funded by:
Amgen Canada Inc.; AstraZeneca Canada Inc.; GlaxoSmithKline Inc.;
Merck Canada Inc.; Novartis Pharmaceuticals Canada Inc.; Pfizer
Canada Incorporated; Boehringer Ingelheim (Canada) Ltd.; Hoffman-La
Roche Ltd.; LifeScan Canada Ltd.; and Lundbeck Canada Inc.
• These companies are represented on my advisory
council, offering advice/input but not mandatory
recommendations.