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The contribution of PROMs to health care sustainability Mark Harrison Stirling Bryan Deborah Marshall Nick Bansback.

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Presentation on theme: "The contribution of PROMs to health care sustainability Mark Harrison Stirling Bryan Deborah Marshall Nick Bansback."— Presentation transcript:

1 The contribution of PROMs to health care sustainability Mark Harrison Stirling Bryan Deborah Marshall Nick Bansback

2 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 https://www.cihi.ca/sites/default/files/document/proms_background_may21_en-web.pdf

3 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

4 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 https://www.cihi.ca/sites/default/files/document/proms_background_may21_en-web.pdf

5 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 https://www.cihi.ca/sites/default/files/document/proms_background_may21_en-web.pdf

6 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 https://www.cihi.ca/sites/default/files/document/proms_background_may21_en-web.pdf

7 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 https://www.cihi.ca/sites/default/files/document/proms_background_may21_en-web.pdf

8 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 https://www.cihi.ca/sites/default/files/document/proms_background_may21_en-web.pdf

9 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 https://www.cihi.ca/sites/default/files/document/proms_background_may21_en-web.pdf

10 Sustainability Issues of health care sustainability

11 Sustainability Issues of health care sustainability

12 Sustainability Issues of health care sustainability How PROMs can contribute to sustainability

13 From: Eliminating Waste in Health Care JAMA. 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

14 From: Eliminating Waste in Health Care JAMA. 2012;307(14):1513-1516. doi:10.1001/jama.2012.362 Failure of care delivery Failure of co-ordination of care Overtreatment Administrative issues Pricing failure Fraud and abuse “Business as usual” “Sustainable” (equal to growth in GDP) The wedge: sources of waste

15 From: Eliminating Waste in Health Care JAMA. 2012;307(14):1513-1516. doi:10.1001/jama.2012.362 Care delivery failure Poor co-ordination Overtreatment Administrative issues Pricing failure Fraud and abuse “Business as usual” “Sustainable” (equal to growth in GDP) Waste & inefficiency The wedge: the cheese

16 The potential of PROMs to improve efficiency

17 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)

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19 Stirling Bryan PROMs: from technology appraisal to technology management

20 Deborah Marshall PROMs as an outcome for continuous quality improvement

21 Nick Bansback PROMs to support informed patient decision-making

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24 Format 3 presentations of 15 mins 5 mins for questions after each presentation Open discussion

25 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.

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