Patient-reported outcomes in the Netherlands
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1 Patient-reported outcomes in the Netherlands Routine use in clinical practice and performance measurement Philip van der Wees The King s Fund, London December 3, 2013
2 From global perspective to local application 1. PRO measurement: perspectives from experts and leaders in the United States, England, and the Netherlands 2. Current application in the Netherlands at national level 3. Use of Routine Outcome Monitoring in mental health services
3 Perspectives of experts and leaders in 3 countries Feasibility of using patient-reported outcomes in clinical practice and performance measurement Philip Van der Wees, Maria Nijhuis-van der Sanden, John Ayanian, Nick Black, Gert Westert, and Eric Schneider
4 Key questions 1. What are current approaches for using PRO measures in clinical practice and performance measurement? 2. What are determinants for further implementation? 3. Is it possible to integrate the collection of PRO for uses in clinical practice and performance measurement?
5 Participants (n=58; 88% response) Country Reporting Measure Clinical practice programs developers United States The Netherlands England 3 3 4
6 Current Approaches in PRO measurement National approaches for performance measurement: NHS (England), CMS (US), Miletus (Netherlands) Local approaches for use in clinical practice: individual healthcare organizations, predominantly in the US and the Netherlands Integrated approaches for use in clinical practice and performance measurement: Minnesota Community Measurement (US), and Mental Health Services (Netherlands)
7 Integration of PRO measurement Report x EHR Feedback Database
8 Data collection for different purposes Is it possible to integrate data collection for PRO measurement in clinical practice and performance measurement? Advantages of integrated data collection: Meaningful use in clinical management and quality improvement No duplication of efforts multiple uses of data Disadvantages of integrated data collection: Establishing routine data collection in clinical practice Establishing realible and valid data for performance measurement Tension between providers and purchasers
9 National approach Patient-Reported Experience (PREMS) and Outcomes (PROMs) by the Miletus Foundation With acknowledgement to Caroline van Weert 1 1 Director of Miletus Foundation
10 National approach Miletus is collaborative of purchasers PREMs + PROMs after treatment Post-then-pre-test design Pilots for ~10 conditions (elective surgery, chronic conditions) Sample of patients via purchasers Online, reminder, paper questionnaire Example: Hip and Knee replacement: HOOS-PS, KOOS-PS, VAS, EQ5D N=73 orthopedic departments/clinics N=13,228 patients Response: 71%
11 Kwaliteit van zorg bespreekbaar
12 Kwaliteit van zorg bespreekbaar
13 Kwaliteit van zorg bespreekbaar
14 Integrated Approach Routine Outcome Monitoring in mental health services With acknowledgement to Edwin de Beurs 1 and Annet Nugter 2 1 Scientific Director National Benchmark Mental Health 2 Head of research mental health service GGZ Noord-Holland-Noord
15 Routine Outcome Monitoring Initiated by individual organizations in mental health services Data collected at clinical level for screening, diagnosis, evaluation of care National policy since 2011: mandate to submit data to national registry Benchmark for internal use at provider level Quality Improvement Benchmark at organizational level for purchasers - Contracting Pay for performance based on data submission (process)
16 Routine Outcome Monitoring In all patient groups: children, adolescents, adults, elderly Set of generic and specific instruments Assessments pre-, during and post-treatment Example: Mental disorders: Outcome Questionnaire (OQ-45) Symptomatic Distress (SD) Interpersonal Relations (IR) Social Role (SR)
17
18 Adult patients (n=1540): pre-post change Total score* Symptomatic Dis.* Interpersonal Rel.* Social Role* 10 0 First assessment Last assessment
19 OQ-45 rate of change and treatment duration sessions 6-9 sessions sessies > 16 sessions
20
21 Conclusions 1. Two separate worlds: PRO in clinical practice and PRO for performance measurement 2. Example of mental health shows feasibility of integrated approach, but also tension between providers and purchasers 3. Main challenges: establishing routine and valid (electronic) data collection; bridging different interests of providers and purchasers 4. Further policy: Tailoring to system characteristics; bringing patients in the lead
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