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Blogger's Note: in absence of the full text further explanation is required as to the type/extent of gyn cancer surveillance
Abstract
Lynch
syndrome (LS), one of the most frequent forms of hereditary colorectal
cancer (CRC), is caused by a defect in one of the mismatch repair (MMR)
genes. Carriers of MMR defects have a strongly increased risk of
developing CRC and endometrial cancer. Over the last few years,
value-based healthcare has been introduced as an approach to the
cost-effective delivery of measurable patient value over complete cycles
of care. This requires all involved stakeholders to formulate and
validate 'patient value' for Lynch syndrome, as well as to identify
targets and associated costs. The aim of this study was to develop a
value-based care model for Lynch syndrome that can determine patient
value and associated costs, and to design a coordinated care pathway
from existing guidelines. All specialists in our hospital involved in
the management of LS patients evaluated the care delivered to these
patients at their department and formulated outcome measures relevant to
patient value.
Patients were then invited to complete a questionnaire that assessed the importance of these measures on a scale of 1-10. Six high-value outcomes were identified: (1) prevention of cancer or detection of early stage cancer (2) rapid results from MMR gene mutation testing (3) rapid investigation of the colon and uterus (4) no/little pain during colonoscopy and gynaecologic examination/biopsy (5) the offer of psychological help and (6) registration with the Dutch Lynch syndrome registry. A total of 38 (59 %) out of 62 patients completed the questionnaire. The relevance of all outcomes was confirmed by the patients and mean scores varied from 7.2 to 9.9. Patients underscored the relevance of both proper patient education and the efficiency of surveillance during their care cycle. Value-based care delivery for Lynch syndrome includes the implementation of six parameters related to prevention and early detection of cancer, a short cycle time and registration to ensure continuation of care. Estimated costs are <euro> 3320 for the first cycle of care (<euro> 3550 including gynaecologic surveillance) and approximately 720 per subsequent annual cycle (<euro> 950 including gynaecologic surveillance).
Patients were then invited to complete a questionnaire that assessed the importance of these measures on a scale of 1-10. Six high-value outcomes were identified: (1) prevention of cancer or detection of early stage cancer (2) rapid results from MMR gene mutation testing (3) rapid investigation of the colon and uterus (4) no/little pain during colonoscopy and gynaecologic examination/biopsy (5) the offer of psychological help and (6) registration with the Dutch Lynch syndrome registry. A total of 38 (59 %) out of 62 patients completed the questionnaire. The relevance of all outcomes was confirmed by the patients and mean scores varied from 7.2 to 9.9. Patients underscored the relevance of both proper patient education and the efficiency of surveillance during their care cycle. Value-based care delivery for Lynch syndrome includes the implementation of six parameters related to prevention and early detection of cancer, a short cycle time and registration to ensure continuation of care. Estimated costs are <euro> 3320 for the first cycle of care (<euro> 3550 including gynaecologic surveillance) and approximately 720 per subsequent annual cycle (<euro> 950 including gynaecologic surveillance).
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