Value-Based Breast Cancer Care: A Multidisciplinary Approach for Defining Patient-Centered Outcomes

Oluwadamilola M. Fayanju, Tinisha L. Mayo, Tracy E. Spinks, Seohyun Lee, Carlos H. Barcenas, Benjamin D. Smith, Sharon H. Giordano, Rosa F. Hwang, Richard A. Ehlers, Jesse C. Selber, Ronald Walters, Debu Tripathy, Kelly K. Hunt, Thomas A. Buchholz, Thomas W. Feeley, Henry M. Kuerer

Value in healthcare-i.e., patient-centered outcomes achieved per healthcare dollar spent-can define quality and unify performance improvement goals with health outcomes of importance to patients across the entire cycle of care. We describe the process through which value-based measures for breast cancer patients and dynamic capture of these metrics via our new electronic health record (EHR) were developed at our institution. Contemporary breast cancer literature on treatment options, expected outcomes, and potential complications was extensively reviewed. Patient perspective was obtained via focus groups. Multidisciplinary physician teams met to inform a 3-phase process of (1) concept development, (2) measure specification, and (3) implementation via EHR integration. Outcomes were divided into 3 tiers that reflect the entire cycle of care: (1) health status achieved, (2) process of recovery, and (3) sustainability of health. Within these tiers, 22 patient-centered outcomes were defined with inclusion/exclusion criteria and specifications for reporting. Patient data sources will include the Epic Systems EHR and validated patient-reported outcome questionnaires administered via our institution's patient portal. As healthcare costs continue to rise in the United States and around the world, a value-based approach with explicit, transparently reported patient outcomes will not only create opportunities for performance improvement but will also enable benchmarking across providers, healthcare systems, and even countries. Similar value-based breast cancer care frameworks are also being pursued internationally.