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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
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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 • Generice.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 • Knee arthroplasty (EQ-5D, SF-12) • Alberta • Hip & 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 • Knee arthroplasty (EQ-5D, SF-12) • Alberta • Hip and knee arthroplasty (SF-36, WOMAC) • Heart and Lung Transplant Clinic • U of A Hospital (HUI2, HUI3) • Saskatchewan • Joint arthroplasty (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 • Knee arthroplasty (EQ-5D, SF-12) • Alberta • Hip and knee arthroplasty (SF-36, WOMAC) • Heart and Lung Transplant Clinic • U of A Hospital (HUI2, HUI3) • Saskatchewan • Joint arthroplasty (EQ-5D) • Spinal surgery (EQ-5D) • Manitoba • Winnipeg Joint Replacement Group • (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 • Knee arthroplasty (EQ-5D, SF-12) • Alberta • Hip and knee arthroplasty (SF-36, WOMAC) • Heart and Lung Transplant Clinic • U of A Hospital (HUI2, HUI3) • Saskatchewan • Joint arthroplasty (EQ-5D) • Spinal surgery (EQ-5D) • Manitoba • Winnipeg Joint Replacement Group • (SF-12, Oxford Scores) • Ontario • 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 • Knee arthroplasty (EQ-5D, SF-12) • Alberta • Hip and knee arthroplasty (SF-36, WOMAC) • Heart and Lung Transplant Clinic • U of A Hospital (HUI2, HUI3) • Saskatchewan • Joint arthroplasty (EQ-5D) • Spinal surgery (EQ-5D) • Manitoba • Winnipeg Joint Replacement Group • (SF-12, Oxford Scores) • Ontario • 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 Waste & inefficiency 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
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; BoehringerIngelheim (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.