International Consortium for
Health Outcomes Measurement
Dr James Kent, BCG
Dr Tom Kelley, ICHOM
Kings Fund
18th November 2014
Evolving healthcare systems
Accountable care
...ensuring payments are
linked to outcomes
Value-based health
care
...ensuring decisions are
framed as outcomes over
input costs
Integrated care
Outcomes
focused
...ensuring many providers
can coordinate to deliver
outcomes
Bundled care
..ensuring payment covers
all aspects of care around
a procedure
141118-ICHOM-Kings Fund-Final.pptx
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
1
Problem
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
141118-ICHOM-Kings Fund-Final.pptx
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
2
Solution
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
141118-ICHOM-Kings Fund-Final.pptx
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
3
Three objectives
1
Define internationally recognized Standard Sets of outcomes
▪ Together with risk adjustment factors
2
Drive the adoption of Standard Sets globally
▪ Wide dissemination among clinicians and patient groups
3
Create global communities focused on outcome comparison
• Support learning, and practice improvement
141118-ICHOM-Kings Fund-Final.pptx
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
4
Localized Prostate Cancer Set
Treatment approaches
covered
▪
▪
▪
▪
▪
▪
▪
Watchful waiting
Active surveillance
Prostatectomy
External beam radiation therapy
Brachytherapy
Androgen Deprivation Treatment
Other
Details
1 Recorded via the Clavien-Dindo-Classification
2 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
141118-ICHOM-Kings Fund-Final.pptx
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
5
Prostate Cancer Working Group
Adam Glaser, St James’ Institute
of Oncology; NHS
Jim Catto, University of Sheffield,
European Urology
Anna Bill-Axelson,
Swedish Prostate
Cancer Registry
Hartwig Huland and Markus Graefen,
Martini Klinik
Michael Froehner,
Günter Feick*, Bundesverband
Prostatakrebs Selbsthilfe (BPS); Europa
UOMO
Thomas Wiegel, University Hospital Ulm
Frank Sullivan
Prostate Cancer Institute
John Fitzpatrick, Irish
Cancer Society
C.H. Bangma, Erasmus
Medical Center
Steven Jay Frank, MD Anderson
David Swanson, MD Anderson
Andrew Vickers, MSKCC
Adam Kibel, Dana Farber/BWH
Michael O’Leary, Dana Farber/BWH
Anthony D’Amico, Dana Farber/BWH
Neil Martin, Dana Farber/BWH
Michael Blute, MGH
Howard Sandler, Cedars-Sinai
Ronald Chen, University of North
Carolina
Dan Hamstra, University of Michigan
Ash Tewari, Weill Cornell Medical
College
Francesco Montorsi, European Urology
Editor in Chief
Alberto Briganti, Vita-Salute San
Raffaele University Hospital, Milan
Jabob Ramon, Sheba
Medical Center
Kim Moretti, South Australian Prostate
Cancer Clinical Outcome Collaborative
Mark Frydenberg, Prostate Cancer
Registry of Victoria
Ian Roos*, Cancer Voices Victoria
*Patient representative
141118-ICHOM-Kings Fund-Final.pptx
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
6
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
141118-ICHOM-Kings Fund-Final.pptx
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
7
Criteria to prioritise outcomes
Example: Complications after spine surgery, part of Low Back Pain Standard Set
Frequency
(5=high)
Suggest not
Including
Up for
Debate
Suggest
Including
Outcome
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
+
+
+++
++++
141118-ICHOM-Kings Fund-Final.pptx
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
8
Criteria to select PROMs
Example: Selecting the best measure of disability in Low Back Pain
ODI short and well translated, license
grants access to high-quality
translations
Top 10 frequently cited measures of
function in LBP (2001-2011)
# of citations
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
Clinical
interpretability
+++
+
+
200
150
100
50
0
ODI Roland RoM COMI*Quebec FCE
Morris
LBP- Schober PSFS Trunk
RS
flex
* 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 scale
Source: 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
141118-ICHOM-Kings Fund-Final.pptx
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
9
Standard Sets
All Sets contain Patient Reported Outcomes
ODI
SAQ-7
Cleft-Q
NMSQuest
NPS
PHQ-2
NOSE scale
PDQ-8
EQ-5D
Rose
PRO tools
MDS-UPDRS
141118-ICHOM-Kings Fund-Final.pptx
Catquest 9SF
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
10
ICHOM Sets that we are developing
141118-ICHOM-Kings Fund-Final.pptx
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
11
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
141118-ICHOM-Kings Fund-Final.pptx
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
12
Driving adoption in the UK
Existing collaboration
Supporting the development
of our Sets
141118-ICHOM-Kings Fund-Final.pptx
Potential Pilot Sites
Leading centres working to
use our Sets
National adoption
Sets used by national
measurement efforts
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
13
Creating communities: global network for CLP
Group of 12 hospitals formed – aim to begin collection mid 2015
141118-ICHOM-Kings Fund-Final.pptx
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
14
Recap: three objectives
1
Define internationally recognized Standard Sets of outcomes
2
Drive the adoption of Standard Sets globally
3
Create global communities
▪ Building on the best
▪ Open Source to encourage roll-out
▪ Driving comparison, learning, and practice improvement
141118-ICHOM-Kings Fund-Final.pptx
Copyright © 2013 by the International Consortium for Health Outcomes Measurement. All rights reserved.
15