Value-Based Breast Cancer Care: A Multidisciplinary Approach for Defining Patient-Centered Outcomes.


Journal Article

PURPOSE: Value in healthcare-i.e., patient-centered outcomes achieved per healthcare dollar spent-can define quality and unify performance improvement goals with health outcomes of importance to patients across the entire cycle of care. We describe the process through which value-based measures for breast cancer patients and dynamic capture of these metrics via our new electronic health record (EHR) were developed at our institution. METHODS: Contemporary breast cancer literature on treatment options, expected outcomes, and potential complications was extensively reviewed. Patient perspective was obtained via focus groups. Multidisciplinary physician teams met to inform a 3-phase process of (1) concept development, (2) measure specification, and (3) implementation via EHR integration. RESULTS: Outcomes were divided into 3 tiers that reflect the entire cycle of care: (1) health status achieved, (2) process of recovery, and (3) sustainability of health. Within these tiers, 22 patient-centered outcomes were defined with inclusion/exclusion criteria and specifications for reporting. Patient data sources will include the Epic Systems EHR and validated patient-reported outcome questionnaires administered via our institution's patient portal. CONCLUSIONS: As healthcare costs continue to rise in the United States and around the world, a value-based approach with explicit, transparently reported patient outcomes will not only create opportunities for performance improvement but will also enable benchmarking across providers, healthcare systems, and even countries. Similar value-based breast cancer care frameworks are also being pursued internationally.

Full Text

Duke Authors

Cited Authors

  • Fayanju, OM; Mayo, TL; Spinks, TE; Lee, S; Barcenas, CH; Smith, BD; Giordano, SH; Hwang, RF; Ehlers, RA; Selber, JC; Walters, R; Tripathy, D; Hunt, KK; Buchholz, TA; Feeley, TW; Kuerer, HM

Published Date

  • August 2016

Published In

Volume / Issue

  • 23 / 8

Start / End Page

  • 2385 - 2390

PubMed ID

  • 26979306

Pubmed Central ID

  • 26979306

Electronic International Standard Serial Number (EISSN)

  • 1534-4681

Digital Object Identifier (DOI)

  • 10.1245/s10434-016-5184-5


  • eng

Conference Location

  • United States