International Consortium for Health Outcomes Measurement (ICHOM), Cambridge, Massachusetts2Department of Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts3Division of Hematology and Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
International Consortium for Health Outcomes Measurement (ICHOM), Cambridge, Massachusetts4Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
JAMA Oncol. 2017 May 1;3(5):686-694. doi: 10.1001/jamaoncol.2017.0417.
Global health systems are shifting toward value-based care in an effort to drive better outcomes in the setting of rising health care costs. This shift requires a common definition of value, starting with the outcomes that matter most to patients.
The International Consortium for Health Outcomes Measurement (ICHOM), a nonprofit initiative, was formed to define standard sets of outcomes by medical condition. In this article, we report the efforts of ICHOM's working group in colorectal cancer.
The working group was composed of multidisciplinary oncology specialists in medicine, surgery, radiation therapy, palliative care, nursing, and pathology, along with patient representatives. Through a modified Delphi process during 8 months (July 8, 2015 to February 29, 2016), ICHOM led the working group to a consensus on a final recommended standard set. The process was supported by a systematic PubMed literature review (1042 randomized clinical trials and guidelines from June 3, 2005, to June 3, 2015), a patient focus group (11 patients with early and metastatic colorectal cancer convened during a teleconference in August 2015), and a patient validation survey (among 276 patients with and survivors of colorectal cancer between October 15, 2015, and November 4, 2015).
After consolidating findings of the literature review and focus group meeting, a list of 40 outcomes was presented to the WG and underwent voting. The final recommendation includes outcomes in the following categories: survival and disease control, disutility of care, degree of health, and quality of death. Selected case-mix factors were recommended to be collected at baseline to facilitate comparison of results across treatments and health care professionals.
A standardized set of patient-centered outcome measures to inform value-based health care in colorectal cancer was developed. Pilot efforts are under way to measure the standard set among members of the working group.
为了在医疗成本不断上升的情况下实现更好的医疗效果，全球医疗体系正在向以价值为基础的医疗服务模式转变。这种转变需要对价值有一个共同的定义，首先要确定对患者最重要的结果。
国际卫生保健结果测量协会（ICHOM）是一个非营利组织，旨在为各种病症定义一套标准的结果测量集。在本文中，我们报告了 ICHOM 工作组在结直肠癌方面的工作。
该工作组由来自医学、外科、放射治疗、姑息治疗、护理和病理学等多学科的肿瘤学专家以及患者代表组成。通过为期 8 个月（2015 年 7 月 8 日至 2016 年 2 月 29 日）的改良 Delphi 流程，ICHOM 领导工作组就最终推荐的标准集达成了共识。该流程得到了系统的 PubMed 文献综述（2005 年 6 月 3 日至 2015 年 6 月 3 日的 1042 项随机临床试验和指南）、患者焦点小组（2015 年 8 月举行的一次电话会议上的 11 名早期和转移性结直肠癌患者）和患者验证调查（2015 年 10 月 15 日至 11 月 4 日期间患有和幸存的 276 名结直肠癌患者）的支持。
在整合文献综述和焦点小组会议的结果后，向工作组提交了一份包含 40 项结果的清单，并进行了投票。最终的推荐结果包括以下几类：生存和疾病控制、治疗护理的不舒适程度、健康程度和死亡质量。推荐收集一些基线病例组合因素，以促进治疗方法和卫生保健专业人员之间的结果比较。
开发了一套以患者为中心的标准化结果测量指标，以指导结直肠癌的以价值为基础的医疗保健。目前正在工作组成员中开展试点工作，以衡量标准集的实施情况。
