VBHC to deliver excellent radiotherapytreatment: optimizing patient value for oncology patients throughcontinuous quality improvement.

By Maastro

Background: Maastro is international wellknown and recognized top specialist center focused on radiotherapy
for patients with cancer. In addition to the top specialist treatment of patients, Maastro is also a renowned
research institute with 5 research divisions ranging from pre-clinical (lab research and physics research), clinical
and post-clinical (clinical data science and implementation innovation) research, with a total of +/- 140
researchers (e.g. PhDs, postdocs, assistant professors and associate professors) led by 8 professors.

Maastro is geographically located attached to Maastricht University Medical Center+ (MUMC+), which facilitates
precise coordination of chirurgical and radiotherapy treatment for oncology patients. As radiotherapy institute
we are partner in the Comprehensive Cancer Center Maastricht of MUMC+. Moreover, Maastro closely
collaborates with 9 hospitals located in the South-East of the Netherlands in a collaboration called ‘OncoZON’
(Oncologisch Netwerk Zuidoost-Nederland). Unique for this network is that all institutes have contractually
agreed to follow the same procedures and working methods to, ultimately, ensure they provide the best
oncology care for their patients. Maastro’s radiation oncologists lead quality improvement within the network.
This unique position facilitates the upscaling and further dissemination of VBHC-focused methodologies
developed in Maastro to steer towards quality improvement within the OncoZON network.
Uniqueness: Since Maastro is an independent radiotherapy center, it is relatively small and adapts easily to new
insights and innovations. With our innovative drive we achieve high goals, like facilitating proton therapy, being
granted as International Brachytherapy Centre of Excellence and has the Ministry of Health, Welfare and Sport
(VWS) recognized Maastro as Top Specialist Institute (TZO). To stay on top of new developments, Maastro
pursues a scientific environment, that has led to 5 international renowed research divisions with their own
professors (8 in total). In this sensory working environment, our clinicians are driven to continuously enhance
their care through Maastro’s VBHC program in order to continuously improve patient-relevant outcomes.

Aim: Inspired by Porter’s Value Agenda, Maastro developed a bottom-up structure committed to continuous
quality improvement of radiation treatment, based on a specific methodology, within the institute using
structurally registered and internationally validated outcome sets that matter most to oncology patients.
Maastro aims to continuously steer content-driven Plan-Do-Study-Act cycles towards optimized patient value
per tumour care line (driven by doctors that participate actively in action teams).

Relevance of initiative: Particularly in radiotherapy, characterized by rapidly evolving innovations that aim to
enhance patient health outcomes, adoption of new radiotherapy interventions needs careful considerations of
the patient value and the extent of evidence for the outcomes and costs1. With the increasing demand for
healthcare and increasingly scarcer resources, embracing the principles of VBHC allows for improving the current
quality of care defined by outcomes that matter most to oncology patients and simultaneously limit the increase
of healthcare costs. Within the VBHC program the needed data is visualized and discussed with healthcare
professionals (within actionteams per tumour type) without increasing registration burdens.

Patient description: Patients with cancer that are treated with radiotherapy.

Patient involvement: Actively eliciting the patient perspective in improving quality of care is imperative. The
Client Council and the digital patient panel are consulted to validate the relevance of the ICHOM outcomes for
Maastro’s patients undergoing radiotherapy and to advise on the relevance and selection of improvement
initiatives (more in depth information is provided in part 3.1). Patients in the panel are mainly consulted through

digital means, such as online questionnaires. Notably, patient satisfaction, is regarded of high importance by
Maastro and is currently rated 9.2 out of 102.

Methods, size and scope: Maastro’s VBHC program uses a structured methodology to empower innovation
minded radiotherapy teams towards continuous improvement. Firstly, the selection of patient-relevant
outcomes and case mix variables according to the outcome sets defined by ICHOM is made, per tumour type
(medical condition). These variables are matched with the Patient-Reported Outcomes (PROs) and Doctor
Reported Outcomes (DROs). Secondly, insightful dashboards with trustworthy data are composed, to enable
adequate analysis of outcomes and improvement potential. Thereafter, dedicated project managers steer
content-driven Plan-Do-Study-Act (PDSA) cycles, based on the dashboards in combination with external
references, such as leading scientific literature. Implementation of new VBHC interventions applies to each
tumour care line separately. The structured approach of the VBHC program of Maastro is illustrated in the figure
below:

Preliminary results: The VBHC program of Maastro has several interesting and impactfull interventions with improving the patient value. By using the developed methodology Maastro is able to continously stimulate similar transformations.

Although we can mention several excellent examples of Maastro’s VBHC program (see figure above), due to the word limit we limit the description of this application to an impactfull intervention for patients diagnosed with non-small cell lung cancer (NSCLC), orange in the figure above, to improve their patient value in the full care cycle (more details in part 3). During the course of this application we refer to this as the ‘NSCLC intervention’.