Abstract
Purpose of ReviewThe 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.Recent FindingsThis 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.SummaryHealth 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.
Highlights
Head and neck cancer (HNC) is characterized by often relatively fast growing tumors in anatomically delicate and functionally vulnerable sites
This review presents a summary of some important aspects of quality of care in HNC
One simple process indicator is the presence of a multidisciplinary team (MDT)
Summary
Head and neck cancer (HNC) is characterized by often relatively fast growing tumors in anatomically delicate and functionally vulnerable sites. VBHC aims to provide outcomes favorable to patients at the fairest possible costs It should keep health systems sustainable and continually improving. Morbidity, length of hospitalization, and costs were associated with higher hospital volume [24] Another example in HNC is the recently published association between involved surgical margin rates and facility volume for patients with oropharyngeal carcinoma treated by transoral robotic surgery [33]. Even in less complex cases experience is important for optimal outcomes and appropriate costs In this regard, organization of the HNC patient’s pathway into a “hub and spoke” network model should improve patient satisfaction and quality of care, as suggested with other cancers [35, 36]. One simple process indicator is the presence of a multidisciplinary team (MDT)
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