Implementation of Value Based Breast Cancer Care.

Area of Science:

• Oncology
• Health Services Research
• Value-Based Healthcare

Background:

• Integrating patient-reported outcomes (PROs) and provider-reported outcomes is essential for enhancing the value of care in oncology.
• A single academic breast cancer center implemented a system for collecting and utilizing both provider and patient outcome data.

Purpose of the Study:

• To describe the development of a comprehensive outcomes set for breast cancer care.
• To detail the integration of this data within electronic health records (EHR).
• To illustrate the clinical application of collected outcome data for improving patient care.

Main Methods:

• An Integrated Practice Unit (IPU) was established to manage the full breast cancer patient care cycle.
• Provider-reported outcomes and PROs were defined through multidisciplinary focus groups and surveys.
• Patient pathways were redesigned to optimize data collection points throughout the care continuum.

Main Results:

• A Standard Set for Breast Cancer Outcomes, including case-mix variables and timelines, was established within the IPU.
• A secure electronic platform linked to the EHR was developed for measuring PROs during outpatient care.
• Initial evaluation indicated a decline in PRO response rates over time (83.3% at baseline to 45.2% at 12 months post-surgery), though patients responded positively to PRO use in clinical settings.

Conclusions:

• The assessment of both patient-reported and provider-reported outcomes has been successfully integrated into standard breast cancer care.
• Successful implementation required dedicated resources, cultural and practice changes, and enhanced understanding of Value-Based Healthcare (VBHC).
• The developed framework serves as a potential blueprint for implementing VBHC in routine clinical practice.