Value-based radiology in cancer care: it's about the entire care pathway
European Society of Radiology (ESR) President Prof. Lorenzo Derchi gave a lecture on value-based radiology (VBR) in cancer care at the 2018 European Cancer Summit, organised by the European CanCer Organisation (ECCO) in September 2018 in Vienna, Austria.
As part of the New Horizon Session "Access and Value: It's about the entire cancer pathway", Prof. Derchi introduced the ESR's concept on value-based radiology as a way of ensuring radiology systems become more financially sustainable while also providing better care to patients. The ESR's analysis starts with what is measured as having value in healthcare: the current value-based healthcare (VBHC) concept begins its assessment of value after treatment starts. However, this means that it does not consider the "entire" care pathway: the diagnostic process is not included in the value equation other than as a simple cost factor.
The ESR's value-based radiology concepts proposes a correct, timely, and useful diagnosis as the first outcome that matters to patients, and other healthcare professionals. As such, it should be considered as a part of the value-based healthcare paradigm. Only if value-based approaches start with the perspective of patients first consulting a doctor as individuals seeking help and a cure for certain signs and symptoms can they be considered to cover the entire pathway of patient care.
This requires a new way of thinking about organising and financing healthcare services in radiology, moving away from volume-based approaches - paying for the amount of services provided irrespective of their quality or utility - towards value-based approaches focusing on the value provided by diagnostics.
Value measurements in healthcare need to take into account more than service volumes and cost
The ESR Subcommittee on Value-Based Radiology's concept paper identifies five key factors that can be used to start quantifying the value provided by radiology:
- Appropriateness of requests
- Attention to radiation protection measures
- Characteristics of the reports (correct, complete, well understandable, structured and properly used)
- Relationships between patients and radiology personnel
- Continuous professional education, research and innovation
Using a case study from breast cancer care, Prof. Derchi argued that value-based concepts need to take into account what happens before a patient's first visit to an oncology specialist. Typically, this would involve a visit to the patient's family doctor, followed by a cancer diagnosis based on breast imaging and an image-guided biopsy. Several factors will have a significant impact on the speed and quality of the services provided, as well as the patient's experience:
- Did the family doctor request the correct imaging tests (the first time)?
- How long was the patient's waiting time?
- Did the radiographer/radiologist pay attention to technique optimisation?
- Where there any complications from the biopsy?
- Where the imaging and pathology reports accurate, complete, and understandable?
- Where the results provided quickly to the referring physician and patient?
- How were the news communicated to the patient?
ESR President Prof. Lorenzo Derchi presenting the ESR's approach to value-based radiology in cancer care
Establishing practical metrics for diagnostics requires more work, but some of the value provided in these first steps in the care pathway can be captured by metrics e.g. about quality, correctness, and time-to-diagnosis. But imaging or diagnostics are also essential at later steps in the care pathway, for example before and after surgery, planning treatments and evaluating treatment efficacy, early diagnosis of recurrence, etc.
Prof. Derchi's view of value-based approaches to healthcare is that of an opportunity. Reforms to healthcare services often start because of financial necessity, but establishing more patient-centric, evidence-based, measurable, and outcome-driven healthcare is important in and of itself, even in a system of unlimited resources.
Follow this link for more information on the European Cancer Summit 2018, including Prof. Derchi's presentation.