A lack of information is a major challenge to those working in the health care system. Without information, it is difficult to understand, value, judge, and define how to integrate and maintain technology. If we add in the fragmentation that normally characterizes patient care (particularly for those with chronic diseases), we can understand why the system is at times unsafe and inefficient.
Health care systems can only be high-quality and patient-centered when outcome measurement is a natural output for organizations, when we understand what happens to patients we care for, and when we merge clinical practice with clinical research. In clinical practice we implemented multidisciplinary protocols such as staging exams, treatment protocols, and a multidisciplinary approach to care and follow-up routines for the most prevalent tumors (lung, breast, colorectal, prostate, lymphoma, and gastric cancer).
For this project, our protocols were based on international guidelines, including those from the National Comprehensive Cancer Network. Our program involved following patients from the time of diagnosis until death, while managing their care and measuring clinical outcomes and costs in order to understand and improve the value of the care delivered. For example, strategies were designed to control the prescription of chemotherapy, and an IT system was developed with a sequence of rules limiting physicians’ access to relevant pathology specific protocols for the patients receiving care. A scientific board of Grupo Clínicas Oncológicas Integradas (Grupo COI) analyzed and validated all prescriptions and performed audits to monitor compliance with the institution’s defined protocols.
Phase I of the evaluation included a retrospective analysis of demographic information from patients treated at Grupo COI since 2001. The data focused on their overall survival, and the rates were comparable with other published data.
Phase II of the evaluation included a prospective analysis based on protocols implemented within the institution, specifically for lung cancer. The two main groups of measures considered were:
- Clinical practices: Compliance with established routines, including staging exams, treatment protocols, multidisciplinary approach, follow-up routines.
- Outcomes: Prospective follow up with patients, evaluation of quality of life, toxicity (surrogate endpoints), and progression-free survival/overall survival (primary endpoints).
Phase II of the evaluation demonstrated 90% compliance with established routines and up to 90% compliance with the internally defined treatment protocols for chemotherapy and radiotherapy for lung cancer patients. As of May 2013, there was 100% compliance with monitoring the identified outcomes.
In order to ensure the program’s success, an organization must have:
- A culture of value that is based on outcome measurement and that is supported by high-level managers and the medical team.
- The health care team’s full engagement.
- Sophisticated information technology (IT) infrastructure and an appropriate IT team.
- Financial support for basic resources including Human Resources and IT.
- A culture of information generation, continuous quality improvement, and innovation across the organization.