title: Value-Based Breast Cancer Care: A Multidisciplinary Approach for Defining Patient-Centered Outcomes.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Oluwadamilola M
authors.initials: OM
authors.lastname: Fayanju
authors.affiliation: Office of the Senior Vice President (SVP), Hospital and Clinics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Tinisha L
authors.initials: TL
authors.lastname: Mayo
authors.affiliation: Office of the Senior Vice President (SVP), Hospital and Clinics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Tracy E
authors.initials: TE
authors.lastname: Spinks
authors.affiliation: The Institute for Cancer Care Innovation (ICCI), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Seohyun
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Barcenas
authors.affiliation: Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Department of Health Services Research, Division of the Office of the Vice President (OVP), Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Smith
authors.affiliation: Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Department of Health Services Research, Division of the Office of the Vice President (OVP), Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Sharon H
authors.initials: SH
authors.lastname: Giordano
authors.affiliation: Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Rosa F
authors.initials: RF
authors.lastname: Hwang
authors.affiliation: Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Ehlers
authors.affiliation: Department of Plastic Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Selber
authors.affiliation: Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Office of the Executive Vice President (EVP) and Physician-in-Chief, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Walters
authors.affiliation: Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Debu
authors.initials: D
authors.lastname: Tripathy
authors.affiliation: Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.affiliation: Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Office of the Executive Vice President (EVP) and Physician-in-Chief, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.affiliation: The Institute for Cancer Care Innovation (ICCI), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.|The Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Feeley
authors.affiliation: Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. hkuerer@mdanderson.org.|Office of the Senior Vice President (SVP), Hospital and Clinics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. hkuerer@mdanderson.org.
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
mesh_terms: D001943:Breast Neoplasms / Q000628:therapy*; D019468:Disease Management; D057286:Electronic Health Records; D005260:Female; D017144:Focus Groups; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D013781:Texas; D014481:United States; D062505:Value-Based Purchasing