Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Curr Oncol Rep. 2020 Jul 10;22(9):92. doi: 10.1007/s11912-020-00952-5.
The concept of value-based health care (VBHC) was articulated more than a decade ago. However, its clinical implementation remains an on-going 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.
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. 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.
基于价值的医疗保健（VBHC）的概念提出已有十多年。然而，其临床实施仍然是一个持续的过程，对于头颈部癌症（HNC）领域来说尤其具有挑战性。这些癌症通常在功能和美容敏感部位生长迅速的肿瘤，并影响具有不同情况和合并症的患者。此外，各种治疗方式和方案对功能结果的影响也不同。因此，对头颈部肿瘤学中 VBHC 的解释仍然具有挑战性。
本专论回顾了头颈部肿瘤患者 VBHC 的特定方面的发展，包括建立注册处和质量指标（如基础设施、过程和结果指标）。它强调了多学科团队、“治疗时间间隔”以及遵循指南的重要性。讨论涉及主要指标，包括生存、生活质量和功能结果以及不良事件。此外，需要注意列线图、预后和决策模型的优缺点以及护理的差异。医疗保健专业人员必须与患者一起正确定义质量和相关结果，既要考虑个体患者，也要考虑 HNC 人群。至关重要的是要获取和组织相关数据，以便对其进行分析，并利用结果来改善结果和价值。
