Regional initiative to define, collect, and report value metrics in cancer care.

25 Background: In the context of numerous national initiatives aimed at measuring quality and value in cancer care, the Hutchinson Institute for Cancer Outcomes Research, in partnership with local healthcare delivery organizations, patient advocacy groups, payers, and policymakers launched a regional, stakeholder-driven initiative to define 3-5 “value-based metrics” for cancer care for Washington State. Methods: Representatives from major cancer care delivery organizations, patient advocacy groups, payers, and policymakers were invited to participate in a day-long Value Summit. Attendees were tasked with identifying metrics that considered both costs and outcomes. Trained facilitators helped participants identify metrics for 9 domains: appropriate use of effective therapies, adherence to best practices, survival, comprehensive disease management, efficiency of care, hospice/palliative care, patient and family satisfaction with care, patient reported outcomes/preferences and safety. After the initial list was generated, attendees were then asked to rank the metrics on the basis of feasibility to collect, clinical relevance, ability to act on, meaningfulness to multiple stakeholders, and willingness to report statewide. Attendees were then asked to participate in 3 domain-specific facilitated breakout sessions to prioritize the top metrics for each domain. Breakout sessions reported top metrics for a final group prioritization exercise. Following the Summit, attendees provided feedback on the final rankings. The metrics were then presented at a Town Hall style meeting for public comment. Results: Over 70 participants, representing 20 different organizations, identified 750 unique metrics from 9 domains. The prioritization process yielded 3 areas of interest, with 2 specific metrics within each: end of life and palliative care (metric 1, metric 2); adherence to best practices (metric 3, metric 4); and coordinated and efficient care (metric 5, metric 6). Follow-up surveys of Summit attendees and the Town Hall forum showed widespread support for these metrics Conclusions: Using an iterative, transparent, multi-stakeholder process, it is feasible build regional consensus around value metrics in cancer care.