mark harrison cadth proms symposium introduction revised 2
TRANSCRIPT
The contribution of PROMs to health care sustainability
Mark HarrisonStirling BryanDeborah MarshallNick 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/servicesCIHI. 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 specifice.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: CanadaBritish Columbia
PEAK ProjectKnee 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: CanadaBritish Columbia
PEAK ProjectKnee 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: CanadaBritish Columbia
PEAK ProjectKnee 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: CanadaBritish Columbia
PEAK ProjectKnee 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)
ManitobaWinnipeg 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: CanadaBritish Columbia
PEAK ProjectKnee 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)
ManitobaWinnipeg 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: CanadaBritish Columbia
PEAK ProjectKnee 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)
ManitobaWinnipeg 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
From: Eliminating Waste in Health CareJAMA. 2012;307(14):1513-1516. doi:10.1001/jama.2012.362
“Business as usual”
“Sustainable”(equal to growth in GDP)
The wedge: unsustainable health care
From: Eliminating Waste in Health CareJAMA. 2012;307(14):1513-1516. doi:10.1001/jama.2012.362
Failure of care deliveryFailure of co-ordination of careOvertreatment
Administrative issues Pricing failureFraud and abuse
“Business as usual”
“Sustainable”(equal to growth in GDP)
The wedge: sources of waste
From: Eliminating Waste in Health CareJAMA. 2012;307(14):1513-1516. doi:10.1001/jama.2012.362
Care delivery failurePoor co-ordinationOvertreatment
Administrative issues Pricing failureFraud and abuse
“Business as usual”
“Sustainable”(equal to growth in GDP)
Was
te &
ineffi
cienc
y
Was
te &
ineffi
cienc
y
The wedge: the cheese
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 BryanPROMs:from technology appraisal to technology management
Deborah MarshallPROMs as an outcome for continuous quality improvement
Nick BansbackPROMs 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.