Value and Quality of Care in Head and Neck Oncology

Abstract

Purpose of Review The concept of value-based health care (VBHC) was articulated more than a decade ago. However, its clinical implementation remains an ongoing process and a particularly demanding one for the domain of head and neck cancer (HNC). These cancers often present with fast growing tumors in functionally and cosmetically sensitive sites and afflict patients with differing circumstances and comorbidity. Moreover, the various treatment modalities and protocols have different effects on functional outcomes. Hence, the interpretation of what constitutes VBHC in head and neck oncology remains challenging. Recent Findings This monograph reviews developments in specific aspects of VBHC for HNC patients, including establishment of registries and quality indices (such as infrastructure, process, and outcome indicators). It emphasizes the importance of the multidisciplinary team, "time to treatment intervals," and adherence to guidelines. The discussion addresses major indicators including survival, quality of life and functional outcomes, and adverse events. Also, strengths and weaknesses of nomograms, prognostic and decision models, and variation of care warrant attention. Summary Health care professionals, together with patients, must properly define quality and relevant outcomes, both for the individual patient as well as the HNC population. It is essential to capture and organize the relevant data so that they can be analyzed and the results used to improve both outcomes and value. Keywords Head and neck. Cancer. Quality of care. Indicators. Value-based health care This article was written by members and invitees of the International Head and Neck Scientific Group (www.IHNSG.com). This article is part of the Topical Collection on Head and Neck Cancers.

Determinants of delay in the head and neck oncology care pathway: The next step in value‐based health care

“…The organisation of care in a (regional) network, providing efficient communication and collaboration between general practitioners, secondary and tertiary referral centres can decrease TTI and CPI (Takes et al, 2020 ). A major aspect influencing the duration of TTI/CPI is performing diagnostic procedures (i.e.…”

“…Whereas quality of life involves patients’ perspective, all healthcare providers carry a responsibility to define quality of care and advise patients regarding survival and quality of life outcomes. This time interval (‘waiting time’) is a prominent quality indicator involving the care process to establish VBHC (Takes et al, 2020 ).…”

Identification and management of late dysfunction in survivors of head and neck cancer: Implementation and outcomes of an interdisciplinary quality of life (IQOL) clinic

“…9,35 PROs are more sensitive and may be a better means of capturing a patient's perception of their function. [46][47][48][49] We utilized PROs only as a means to screen functions that did not undergo clinical assessment by a provider (i.e., pain, distress, fatigue, and hearing), in an effort to ensure all functions were screened while taking into consideration the time required to fill out multiple surveys. This resulted in no collection of patient-reported information on functions such as eating, taste, xerostomia, and communication.…”

Determinants of delay and association with outcome in head and neck cancer: A systematic review

“…Studies to define an optimal cut-off are needed, using time as continuous variable, to provide evidence-based and possibly tumour-site specific standards. The organization of care in a (regional) network, with efficient communication and collaboration between general practitioners, secondary, and tertiary referral centres can reduce waiting times [11]. Both CPI and TTI are interesting time intervals to study.…”

“…These logistic challenges in the diagnostic and treatmentplanning phase expose HNC patients to delay. Increased time-totreatment initiation is an important quality indicator assessing value-based healthcare [11]. Creating a sustainable healthcare system, providing value-based healthcare (balancing high quality of care at reasonable costs), is a current global topic [11e13].…”