Post on 04-Aug-2020
AplicandoelRWDalavidarealRWDenlamicrogestión.Lagestióndelaclínica.Resultadosincentivadores
Francisco Ayala de la Peña Sección de Oncología médica Sº de Hematología y Oncología médica H. G. Universitario Morales Meseguer, Murcia
Visvanathan, JCO 2017
Atenciónoncológica:relevante,complejayconnecesidaddecambio
Haro,BMC2014
¿Quédatostenemosparalagestióndenuestrosservicios?
¿Quétenemos?¿RWD?
¿Quétenemos?¿RWD?
¿Quénospiden?¿Resultadosdelmundoreal?
¿DondeestánlosRWD?
¿QUÉDATOSQUEREMOSREALMENTEENMICROGESTIÓN?¿PARAQUÉQUEREMOSLOSDATOSENMICROGESTIÓN?
PARASABERLOQUEHACEMOSYHACERLOMEJOR
PARA CONOCER LOS RESULTADOS DE LOS TRATAMIENTOS EN NUESTROS PACIENTES (EFECTIVIDAD)
PARA IDENTIFICAR AREAS MEJORABLES Y MEJORARLAS (CALIDAD)
PARA IDENTIFICAR PROBLEMAS Y RESOLVERLOS (SEGURIDAD)
PARA ORGANIZARNOS MEJOR ASISTENCIALMENTE (GESTIÓN DE ACTIVIDAD Y DE PERSONAL)
PARA ADELANTARNOS A LOS PROBLEMAS (ESTRATIFICACIÓN)
PARASABERLOQUEHACEMOSYHACERLOMEJOR
PARA CONOCER LOS RESULTADOS DE LOS TRATAMIENTOS EN NUESTROS PACIENTES (EFECTIVIDAD)
PARA IDENTIFICAR AREAS MEJORABLES Y MEJORARLAS (CALIDAD)
PARA IDENTIFICAR PROBLEMAS Y RESOLVERLOS (SEGURIDAD)
PARA ORGANIZARNOS MEJOR ASISTENCIALMENTE (GESTIÓN DE ACTIVIDAD Y DE PERSONAL)
PARA ADELANTARNOS A LOS PROBLEMAS (ESTRATIFICACIÓN)
CALIDAD DE VIDASUPERVIVENCIA
CMprecoz(n=1075):SLEporestadio
Oncologíamédica-HMM/HRS
P < 0.000001
SLE 5 a. por estadio I-98% II-96% III-82%
SLE 5 a. por T T1-97% T2-92% T3-86% T4-75%
SLE 5 a. por N N0-97% N1mic-100% N1-95% N2-92% N3-59%
¡SESGOS!
Datos imprecisos o incorrectos
Datos incompletos
Información insuficiente en la HCE
Necesidad de completarla con otras
fuentes de información Limitación en las conclusiones
Limitación en las decisiones
Limitacionesde“nuestrosdatos”
PARASABERLOQUEHACEMOSYHACERLOMEJOR
PARA CONOCER LOS RESULTADOS DE LOS TRATAMIENTOS EN NUESTROS PACIENTES (EFECTIVIDAD)
PARA IDENTIFICAR AREAS MEJORABLES Y MEJORARLAS (CALIDAD)
PARA IDENTIFICAR PROBLEMAS Y RESOLVERLOS (SEGURIDAD)
PARA ORGANIZARNOS MEJOR ASISTENCIALMENTE (GESTIÓN DE ACTIVIDAD Y DE PERSONAL)
PARA ADELANTARNOS A LOS PROBLEMAS (ESTRATIFICACIÓN)
QCP(QOPIcertificationprogram)
Module # MeasureCore 1 Pathology report confirming malignancy*
Core 2 Staging documented within one month of first office visit*
Core 6Pain addressed appropriately (defect-free measure, 3, 4a, and 5)*
Core 9 Documented plan for chemotherapy, including doses, route, and time intervals*
Core 10Chemotherapy intent (curative vs. non-curative) documented before or within two weeks after administration *
Core 21a Smoking status/tobacco use documented in past year *
Core 24 Patient emotional well-being assessed by the second office visit*
Symptom 27 Corticosteroids and serotonin antagonist prescribed with moderate/high emetic risk chemotherapy*
Symptom 33 Infertility risks discussed prior to chemotherapy with patients of reproductive age*
EOL 38 Pain addressed appropriately (defect-free measure, 35, 36a, and 37)*
EOL 45aHospice enrollment and enrolled more than 7 days before death (defect-free measure, 42 and inverse 45)*
Breast 53
Combination chemotherapy received within 4 months of diagnosis by women under 70 with AJCC stage I (T1c) to III ER/PR negative breast cancer**
Breast 54Test for Her-2/neu overexpression or gene amplification*
Breast 56a Trastuzumab not received when Her-2/neu is negative or undocumented (inverse of 56 )*
Breast 57 Trastuzumab received by patients with AJCC stage I (T1c) to III Her-2/neu positive breast cancer**
Breast 59
Tamoxifen or AI received within 1 year of diagnosis by patients with AJCC stage I (T1c) to III ER or PR positive breast cancer**
Colorectal 66 CEA within 4 months of curative resection for colorectal cancer*
Colorectal 68Adjuvant chemotherapy received within 4 months of diagnosis by patients with AJCC stage III colon cancer**
Colorectal 72Adjuvant chemotherapy received within 9 months of diagnosis by patients with AJCC stage II or III rectal cancer**
Colorectal 73
Colonoscopy before or within 6 months of curative colorectal resection or completion of primary adjuvant chemotherapy*
Colorectal 74 KRAS testing for patients with metastatic colorectal
cancer who received anti-EGFR MoAb therapy*Colorectal 75a Anti-EGFR MoAb therapy not received by patients
with KRAS mutation (Inverse of 75 )*
NSCLC 81Adjuvant cisplatin-based chemotherapy received within 60 days after curative resection by patients with AJCC stage II or IIIA NSCLC**
NSCLC 84 Performance status documented for patients with initial AJCC stage IV or distant metastatic NSCLC*
NSCLC 85
Platinum doublet first-line chemotherapy or EGFR-TKI (or other targeted therapy with documented DNA mutation) received by patients with initial AJCC stage IV or distant metastatic NSCLC with performance status of 0-1 without prior history of chemotherapy*
NSCLC 88Positive mutation for patients with stage IV NSCLC who received first-line EGFR tyrosine kinase inhibitor or other targeted therapy*
Module # MeasureCore 1 Pathology report confirming malignancy*
Core 2 Staging documented within one month of first office visit*
Core 6Pain addressed appropriately (defect-free measure, 3, 4a, and 5)*
Core 9 Documented plan for chemotherapy, including doses, route, and time intervals*
Core 10Chemotherapy intent (curative vs. non-curative) documented before or within two weeks after administration *
Core 21a Smoking status/tobacco use documented in past year *
Core 24 Patient emotional well-being assessed by the second office visit*
Symptom 27 Corticosteroids and serotonin antagonist prescribed with moderate/high emetic risk chemotherapy*
Symptom 33 Infertility risks discussed prior to chemotherapy with patients of reproductive age*
EOL 38 Pain addressed appropriately (defect-free measure, 35, 36a, and 37)*
EOL 45aHospice enrollment and enrolled more than 7 days before death (defect-free measure, 42 and inverse 45)*
Breast 53
Combination chemotherapy received within 4 months of diagnosis by women under 70 with AJCC stage I (T1c) to III ER/PR negative breast cancer**
Breast 54Test for Her-2/neu overexpression or gene amplification*
Breast 56a Trastuzumab not received when Her-2/neu is negative or undocumented (inverse of 56 )*
Breast 57 Trastuzumab received by patients with AJCC stage I (T1c) to III Her-2/neu positive breast cancer**
Breast 59
Tamoxifen or AI received within 1 year of diagnosis by patients with AJCC stage I (T1c) to III ER or PR positive breast cancer**
Colorectal 66 CEA within 4 months of curative resection for colorectal cancer*
Colorectal 68Adjuvant chemotherapy received within 4 months of diagnosis by patients with AJCC stage III colon cancer**
Colorectal 72Adjuvant chemotherapy received within 9 months of diagnosis by patients with AJCC stage II or III rectal cancer**
Colorectal 73
Colonoscopy before or within 6 months of curative colorectal resection or completion of primary adjuvant chemotherapy*
Colorectal 74 KRAS testing for patients with metastatic colorectal
cancer who received anti-EGFR MoAb therapy*Colorectal 75a Anti-EGFR MoAb therapy not received by patients
with KRAS mutation (Inverse of 75 )*
NSCLC 81Adjuvant cisplatin-based chemotherapy received within 60 days after curative resection by patients with AJCC stage II or IIIA NSCLC**
NSCLC 84 Performance status documented for patients with initial AJCC stage IV or distant metastatic NSCLC*
NSCLC 85
Platinum doublet first-line chemotherapy or EGFR-TKI (or other targeted therapy with documented DNA mutation) received by patients with initial AJCC stage IV or distant metastatic NSCLC with performance status of 0-1 without prior history of chemotherapy*
NSCLC 88Positive mutation for patients with stage IV NSCLC who received first-line EGFR tyrosine kinase inhibitor or other targeted therapy*
Module # MeasureCore 1 Pathology report confirming malignancy*
Core 2 Staging documented within one month of first office visit*
Core 6Pain addressed appropriately (defect-free measure, 3, 4a, and 5)*
Core 9 Documented plan for chemotherapy, including doses, route, and time intervals*
Core 10Chemotherapy intent (curative vs. non-curative) documented before or within two weeks after administration *
Core 21a Smoking status/tobacco use documented in past year *
Core 24 Patient emotional well-being assessed by the second office visit*
Symptom 27 Corticosteroids and serotonin antagonist prescribed with moderate/high emetic risk chemotherapy*
Symptom 33 Infertility risks discussed prior to chemotherapy with patients of reproductive age*
EOL 38 Pain addressed appropriately (defect-free measure, 35, 36a, and 37)*
EOL 45aHospice enrollment and enrolled more than 7 days before death (defect-free measure, 42 and inverse 45)*
Breast 53
Combination chemotherapy received within 4 months of diagnosis by women under 70 with AJCC stage I (T1c) to III ER/PR negative breast cancer**
Breast 54Test for Her-2/neu overexpression or gene amplification*
Breast 56a Trastuzumab not received when Her-2/neu is negative or undocumented (inverse of 56 )*
Breast 57 Trastuzumab received by patients with AJCC stage I (T1c) to III Her-2/neu positive breast cancer**
Breast 59
Tamoxifen or AI received within 1 year of diagnosis by patients with AJCC stage I (T1c) to III ER or PR positive breast cancer**
Colorectal 66 CEA within 4 months of curative resection for colorectal cancer*
Colorectal 68Adjuvant chemotherapy received within 4 months of diagnosis by patients with AJCC stage III colon cancer**
Colorectal 72Adjuvant chemotherapy received within 9 months of diagnosis by patients with AJCC stage II or III rectal cancer**
Colorectal 73
Colonoscopy before or within 6 months of curative colorectal resection or completion of primary adjuvant chemotherapy*
Colorectal 74 KRAS testing for patients with metastatic colorectal
cancer who received anti-EGFR MoAb therapy*Colorectal 75a Anti-EGFR MoAb therapy not received by patients
with KRAS mutation (Inverse of 75 )*
NSCLC 81Adjuvant cisplatin-based chemotherapy received within 60 days after curative resection by patients with AJCC stage II or IIIA NSCLC**
NSCLC 84 Performance status documented for patients with initial AJCC stage IV or distant metastatic NSCLC*
NSCLC 85
Platinum doublet first-line chemotherapy or EGFR-TKI (or other targeted therapy with documented DNA mutation) received by patients with initial AJCC stage IV or distant metastatic NSCLC with performance status of 0-1 without prior history of chemotherapy*
NSCLC 88Positive mutation for patients with stage IV NSCLC who received first-line EGFR tyrosine kinase inhibitor or other targeted therapy*
PARASABERLOQUEHACEMOSYHACERLOMEJOR
PARA CONOCER LOS RESULTADOS DE LOS TRATAMIENTOS EN NUESTROS PACIENTES (EFECTIVIDAD)
PARA IDENTIFICAR AREAS MEJORABLES Y MEJORARLAS (CALIDAD)
PARA IDENTIFICAR PROBLEMAS Y RESOLVERLOS (SEGURIDAD)
PARA ORGANIZARNOS MEJOR ASISTENCIALMENTE (GESTIÓN DE ACTIVIDAD Y DE PERSONAL)
PARA ADELANTARNOS A LOS PROBLEMAS (ESTRATIFICACIÓN)
PARASABERLOQUEHACEMOSYHACERLOMEJOR
PARA CONOCER LOS RESULTADOS DE LOS TRATAMIENTOS EN NUESTROS PACIENTES (EFECTIVIDAD)
PARA IDENTIFICAR AREAS MEJORABLES Y MEJORARLAS (CALIDAD)
PARA IDENTIFICAR PROBLEMAS Y RESOLVERLOS (SEGURIDAD)
PARA ORGANIZARNOS MEJOR ASISTENCIALMENTE (GESTIÓN DE ACTIVIDAD Y DE PERSONAL)
PARA ADELANTARNOS A LOS PROBLEMAS (ESTRATIFICACIÓN)
Estratificacióndepacientes• Identificar pacientes para
intervenciones con valor probado en prevención o soporte
• Planificar uso de recursos
Mejorarprocesos
PARASABERLOQUEHACEMOSYHACERLOMEJOR
PARA CONOCER LOS RESULTADOS DE LOS TRATAMIENTOS EN NUESTROS PACIENTES (EFECTIVIDAD)
PARA IDENTIFICAR AREAS MEJORABLES Y MEJORARLAS (CALIDAD)
PARA ORGANIZARNOS MEJOR ASISTENCIALMENTE (GESTIÓN DE ACTIVIDAD Y DE PERSONAL)
PARA ADELANTARNOS A LOS PROBLEMAS (ESTRATIFICACIÓN)
PARA IDENTIFICAR Y SOLUCIONAR ÁREAS DE INEFICIENCIA (FÁRMACOS Y NO FÁRMACOS)
GESTIONC
GALEN
http://www.nap.edu/catalog.php?record_id=18359; Feeley, J Am Med Inform Assoc 2014
Shah, J Clin Oncol 2016; Mayo, J Oncol Practice 2017; Miller, J Oncol Practice 2016
Mayo, J Oncol Practice 2017
¿Ylospacientes?¿PRO?¿Calidaddevida?
AcercamientoHCE-paciente
- Necesidad de datos de CV para evaluación de fármacos
- Múltiples aspectos: cumplimiento, actividad física, valores analíticos,
- Conexión paciente y profesionales sanitarios - Acceso libre del paciente a la HCE
¿Resultadosincentivadores?
Gracias