Keys to successful implementation of routine symptom monitoring in head and neck oncology with “Healthcare Monitor” and patients' perspectives of quality of care

Abstract

Background: Value-based health care is increasingly used to facilitate a systematic approach during follow-up of patients. We developed Healthcare Monitor (HM): a structure of electronic patient-reported outcome measures (ePROs) for the longitudinal follow-up of head and neck cancer (HNC) patients. This study shares key lessons from implementation and seeks to provide insight into how patients experience HM. Methods: We conducted a mixed-methods study using quantitative data from a nonrandomized retrospective survey of patients who received HM (n = 45) vs standard care (n = 46) and qualitative data from structured interviews (n = 15). Results: Implementation of HM included significant challenges. Finding common ground among clinicians, administrators, and IT staff was most important. Qualitative findings suggest that patients experienced better doctorpatient communication and increased efficiency of the consultation using HM. Patients felt better prepared and experienced more focus on critical issues. Quantitative analysis did not show significant differences. Conclusions: Integration of HM into routine care for HNC patients may have increased patient-centered care and facilitated screening of symptoms. However, future research is needed to analyze the potential benefits more extensively. K E Y W O R D S head and neck cancer, patient-reported outcome measures, quality assurance, quality of life, value-based health care

The implementation of value-based healthcare: a scoping review

“…Only 22 of the 40 empirical studies evaluated the implemented VBHC components. Eighteen studies measured the effects primarily quantitatively [ 9 , 14 , 15 , 18 , 19 , 24 – 26 , 32 – 35 , 39 – 42 , 44 , 50 ] two qualitatively [ 8 , 29 ] and two studies combined quantitative research methods with a qualitative approach [ 17 , 36 ], using a mixed-methods design. The studies that measured the effects of implementing ‘measure outcomes and costs for every patient’ ( N = 4) reported a decrease in healthcare costs [ 32 ], as well as an increased number of patients that felt that the provider spent enough time with them [ 15 ].…”

“…The qualitative analyses in the two mixed-methods studies found that dedicated resources, change of culture and improved knowledge and awareness about VBHC are crucial for implementation [ 36 ]. Furthermore, patients experienced better doctor-patient communication after VBHC implementation [ 17 ].…”

“…Five articles described the component 'building an enabling information technology platform' , e.g. an interactive application to collect patient experiences or a dashboard [16,17,22,29,36]. Two studies described the implementation of 'move to bundled payments for care cycles [34,50]' .…”

Predicting survival in head and neck cancer: External validation and update of the prognostic model OncologIQ in 2189 patients

“…Information on survival is not a standalone concept and should be combined with information on QoL. Due to the implementation of our Healthcare Monitor 50 we are currently obtaining QoL data. Future research will focus on modeling QoL together with survival.…”

Physicians’ clinical prediction of survival in head and neck cancer patients in the palliative phase

“…Hopefully, this model will take away some reluctance to discuss the prognosis in the palliative phase, and give rise to more realistic prognostic discussions. Due to the implementation of our Healthcare Monitor [48] we are routinely collecting data on the QoL and functioning in the palliative phase, using the EORTC QLQ-C15-PAL [20]. These data can be used in future prognostic research to model QoL.…”