What matters for the Patient…ICHOM Workshop Warsaw 2019

Value Based Health Care in a specialised disease centre

Dr. Burkhard Beyer MD, CMIO

Martini KlinikProstate Cancer Center

Hamburg

The only European institutionexclusively dedicated to prostate cancer

diagnosis and treatment

Martini-Klinik

• Diagnostics (Prostate Cancer Detection)

Different types of imaging:

- Ultrasound

- MRI- PSMA-PET CT

• Local therapy

- Open + robot-assisted Prostatectomy

- Radiotherapy (incl. HDR-, LDR- Brachytherapy)

- Focal therapy- Active Surveillance

• Therapy of metastatic Prostate Cancer

- Androgen Deprivation Therapy

- Immunotherapy

- Chemotherapy

• Psychooncology

• Nutritional Medicine

IPU Integrated Practice Unit

Prostate Cancer

Academic prostate cancer centers

0

500

1000

1500

2000

2500

1 7 13 19 25 31 37 43 49 55 61 67 73 79 85 91 97 103

109

115

121

127

133

139

145

151

157

163

169

175

181

187

193

199

205

211

217

223

229

235

241

247

253

259

265

271

277

283

289

295

301

307

313

319

325

331

337

343

349

355

361

367

373

379

385

391

More than 50% of all RP in Germany were done in hospitals with less 50 RP per year.

# hospitals

# prostatectomies per year

Groeben et al. W J Urol. 2016

Volume and results

Groeben et al. W J Urol. 2016

Volume and results

• Each patient has only one contact person: his treating surgeon

• All are high-volume surgeons - all preforming 200-300 RP/year

• All have a special scientific field of intereste.g. genome analyses, new imaging techniques, metastatic PCa etc.

Faculty system: 12 tenured positions

Prof. M. Graefen Outcome Study Group, Robotic Surgery

Prof. H. Heinzer Resident Education, Events

Prof. H. Huland International Outcome Standardization

Prof. A. Haese Robotic Surgery, Serum/Urine Marker

Prof. T. Steuber Advanced PCa

PD Dr. G. Salomon Focal Therapy, Imaging

Dr. U. Michl QoL, Functional Data

Dr. I. Thederan Organization, Complementary Medicine, Nutrition

PD Dr. L. Budäus Imaging, Fusion biopsies

Prof. Dr. D. Tilki Basic Science

PD Dr. T. Maurer Radioguided Surgery

Super Specialization

• Dr. von Breunig Anesthesiology

• Prof. Dr. Sauter Pathology

• Dr. Schwarz Radiation Therapy

• PD Dr. Beyersdorff Radiology

• Dr. Krüger Psychoonkology

Associated Faculty

Hierarchy

XFaculty

Faculty system: 12 tenured positions

What happens with the patient?

Did I help him with my therapy?What's his quality of life?

PROM – Patient reported outcome measurement

Ask the Patient - PROM

Preoperative

EPIC-26Hereditary PCa

NutritionPhysical activityComorbidities

Postoperative(6-month)

EPIC-26Complications

PSA levelAdditional Treatments

Postoperative(annually)

EPIC-26PSA level

Additional Treatments

Postoperative(1-week)

Urinary functionQoL

• Prostate Cancer Database since 1992• Outcome data from >28.000 patients after Prostate Cancer treatment• Profound preoperative data from each patient and his tumour characteristics

(risk classification)

Database-Problems• No money: not from administration or grants

• No IT-system

• No motivation of the staff

• Critic of the referring urologists

MartiniData

1. Clinical research2. Basic science3. Patient counselling4. Quality control 5. Value based health care

Outcome measurement

One week letter:Continence 1 week after removing the catheter

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

pads

≥4

2/3

0/1

Surgeon 1 2 3 4 5 6 7 8 9 10

pads

/d

Benchmarking - Every 6 months

Benchmarking - Every 6 months

• Postoperative Pain Management• PRO-Survey conducted by the ward nurses• Use of standardized pain questionnaires

• Significant differences in the need of painkillers between open- and robot-assisted radical prostatectomy

• Differences in bowel function

• Adaptation of the generalized postoperative pain management to a individualized therapy per patient and type of surgery

• Introduction of ERAS Principles (Enhanced recovery after surgery)

Interdisciplinary use of PROMS

March 2013Invitation to experts to join the working groupby H. Huland / M. Graefen

28 persons from 9 countries: Experts in Urology, radiotherapy, national registries, statisticians and patient representatives

May 2013Meeting of the working group at the AUA, San Diego

May-December 20136 Telephone conferences, multiple surveys of the working group

November 2013 Manual Localized Prostate Cancer 2nd ICHOM conference, Boston

Creating a Standard Set

www.ichom.org

Treatment modalities

▪ Watchful waiting▪ Active surveillance▪ Prostatectomy▪ External beam radiation▪ Brachytherapy▪ Androgen deprivation▪ others

Only outcome data which matters for the

patients

Conclusion

• Place the needs, wishes, hopes of patients at the centre of attention• Assess data with the help of PROMS• Outcome measurement should be

• Systematic• Standardised• Risk adapted• Transparent• International comparable

• Don't try to be perfect from the beginning…• … just start!

Martinistraße 52 | D-20246 Hamburg

Dr. Burkhard BeyerConsultant Urologist

Phone +49 (0) 40 7410-52272Fax +49 (0) 40 7410-42272

b.beyer@uke.de | www.martini-klinik.de

“It always seems impossible until it's done.” Nelson Mandela