Optimizing Colorectal Cancer Care Pathways to Improve Patient Value
This VBHC Implementation Demonstration Project is focused on value-based re-organization of care delivery and outcomes for people living with colorectal cancer (CRC). It represents the first formal real-time effort to study and optimize the full CRC patient care pathway in a Canadian healthcare system. It is the first documented simultaneous application of key VBHC components in a clinical setting, namely:
1) Developing and organizing care into IPUs;
2) Incorporating PROMs and PREMs collection into standard outcome measurement and care delivery;
3) Building an enabling VBHC data dashboard for tracking and sharing data on relevant outcome indicators;
4) Integrating care across departments by mapping and optimizing the care trajectory;
5) Expanding geographic reach by scaling the implementation framework to other cancer types and centres.
This comprehensive implementation approach enables sustainable value for patients, healthcare providers and organizations, and the public healthcare system. The aim is to achieve the best possible clinical outcomes and overall quality of life outcomes for CRC patients by integrating systematic measurement and utilization of PROMs and PREMs into routine care to support the appropriateness and timeliness of care at every point in the CRC care trajectory. Such integration requires alignment of an organization’s structure, processes and culture with VBHC goals. A key component of this initiative is education and change management at the organizational level. Hence, the implementation plan was co-designed with hospital administrators, researchers and healthcare professionals, patient associations and patients & family caregivers.
Methods: 1) Establishing Project team, governance structure and Strategic Advisory Committee; 2) Mapping the full multidisciplinary service, process and patient care trajectory to identify the optimal complement of healthcare providers for the IPU and understand the current composition of the multidisciplinary team delivering care to CRC patients; 3) defining the purpose and composition of the first-ever Canadian oncology IPU 4) identifying and implementing a set of PROMs and PREMs (consistent with CRC ICHOM set); 5) creating an electronic data platform (dashboard) and algorithm for automating response to patient-reported needs and distress and providing personalized support to CRC patients; and 6) developing a process and infrastructure for collecting, tracking, and linking outcomes and cost data along the care trajectory.
Target population: adult patients referred to and treated for CRC at the cancer centre; patients admitted through emergency department are excluded.
- A new Framework for an IPU in CRC and its implementation;
- A digital platform enabling collection of real-time PROMs & PREMs from patients, and their application to optimize patient care;
- Creation of a VBHC Dashboard including PROMs, PREMs, CROMs and process metrics for use by IPU (clinicians) and Quality department;
- A CRC Care trajectory that will be implemented at the scale of the entire province by the Ministry of Health and Social Services;
- A process for estimating costs over the entire trajectory of care with available data.
Learnings are informing the development of a Canadian VBHC Implementation Framework for scaling to other cancer centres in Canada. By 2024, this Project will be scaled to lung cancer in another center (Quebec City).