Martini-Klinik - the proof, that Michael Porter's VBHC Model works! - Warsaw, January 31st, 2020 - Center of Value Based Healthcare
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Martini-Klinik -
the proof, that Michael Porter’s VBHC Model works!
Warsaw, January 31st, 2020
Universitätsklinikum Hamburg-Eppendorf
Dr. Detlef Loppow
Hospitals offering Radical Prostatectomies 2017
410
Prostate Cancer Centers 2017
Cases
1 Martini-Klinik
Johns Hopkins
Mayo Clinic
2
3-11
350
115 PCa Centers
Open and Robotic Prostatectomies
2800
2600
open robotic
2400
2200
2000
1800
1600
1400
Foundation of
1200
Martini-Klinik
1000
2004
800
600
400
200
0
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
The Patient – the Unknown Subject
Surgery, Recovery, Discharge
– and then?
Nearly no clinic knows anything
about the development of their
Patients after Therapie!
Der Tagesspiegel 06.05.2019
Patient Reported Experience Measures Would you recommend Martini-Klinik to Friends or Family Members?
Integrated Practice Unit
Founded in 2004 as a
specialized clinic for
prostate cancer diagnosis
and treatment
Local therapy:
open/robotic surgery
RTx
HDR and LDR-BrachyTx
AS
focal therapy
Chemo-/immunotherapy
for advanced / metastatic
disease
Diagnostic
> 8,000 outpatient visits
> 1,800 prostate biopsies / imaging procedures
(MRI-fusion / conv. / elastography / HistoScan)Treatment 2019 2,646 radical prostatectomies 100 2nd RG Lymphadenectomies > 400 primary radiation therapies > 200 active surveillance 40 focal therapies
Research Clinical Studies (> 700 Patients included) Scientific Output 2016 (2015): 59 (87) Articles 323 (560) Impact Points > 18 Mio. Euro Industrial and Research Funding since 2008
Outcome Variation
2 x variation in 5 years survival for colorectal cancer between UK primary care trusts
2 x variation in 30-day mortality rate from heart attack in US
4 x variation in bypass surgery mortality in the UK
5 x variation in reoperations due to complications after knee replacement in Germany
6 x variation in emergency readmissions after hip surgery in the UK
9 x variation in complication rates from radical prostatectomies in the Netherlands
10 x variation in mortality after rectal cancer surgery in Sweden
18 x variation in reoperation rates after hip surgery in Germany
20 x variation in mortality after colon cancer surgery in Sweden
22 x variation in reoperation rates within 2 years after hip replacements in Sweden
36 x variation in capsule complications after cataract surgery in Sweden
Source: International Consortium for Health Outcome MeasurementValue Based Health Care
outcomes that matter to patients
Value =
cost per patientWould you judge an airline solely on whether you survived the flight?
Would you judge an airline solely on
whether you survived the flight?
Outcome Quality of Air Travel
I have survived. I arrived in time. Staff were very professional / friendly
The plane live vests on board The plane was clean. Nutrition was of a good quality
The plane had no technical problems. Luggage arrived off the plane without Variety of Entertainment options
any damage or delay.
✓
✓
Then you can only be an average driver...
Healing Continence Potency
PROM Martini-Klinik Database
1 Week after Surgery 4 Questions Early Continency
6 Months after Surgery Degree 3/4 Clavien Dindo Complications
Yearly for 10 Years 26 validated Questions Functional Outcome
Function of the Bladder
EPIC 26 Function of the Gut
Erectile Function
Hormone Therapy
Yearly lifelong 7 Questions Oncologic OutcomeMartini-Klinik Database ▪ Clinical and Outcome Data of more than 30.000 Patients ▪ PROM = Patient Reported Outcome Measurement Outcome Study Group: 2 Data Entry Manager 2 PhD Students 1 Database-Manager 1 Statistician Shipping of about 2,000 Questionnaires per Month (QLQC30, IIEF; IPSS, EPIC 26)
Follow-up Data since 1992
Basic Quality Control – Benchmarking – Science and Research
18000 85.9
90.7
16000 % Patients Sending Follow-Up Information 92.5
14000 93.5
94.2
12000 RP per Year
n Patients
94.5
10000
94.9
8000
94.8
6000 95.2
95.2 Follow-Up Data
4000 95.5
96.6
97.5
97.9 97.6
2000 97.1 98.2 98.0 98.4 98.0 98.6 98.5 98.0
0Basic Quality Control ▪ Revision < 0.2 % ▪ Colon/Urether Injury < 0.2 % ▪ Blood Transfusion < 5 % ▪ MRSA < 0.1 %
Benchmarking - Every 6 Months!
pT2 Tumors
99,4 98,5 98 99,3 100 98,3 100 98,4 98,2 97,7
100
80
60
%
40
20 7,9 7,6 8,8 7,9 9,1
4,3 3 3,5 3 4,5
0
A B C D E F G H I J Surgeo
n
n Nerve Sparing Rate
n Positive Margin Rate 100
Positive Margin Rates
90
Nerve Sparing and
80
70
60
50
40
actually
30
20 previously
10
0Deviation in Quality
5
4
Number of pads 1
3
week post OP
2
1
0
A B C D E F G H
surgeonTransfer of Innovations
2,5
non-FFLU, Mean pads/day = 1.49
P < 0.0001
FFLU, Mean pads/day = 0.87
2
Pads/d (mean)
1,5
Surgeon A
1
Surgeon B
Surgeon C
0,5
0
May 08 Jun 08 Jul 08 Aug 08 Sep 08 Oct 08 Nov 08 Dec 08 Jan 09 Feb 09 Mar 09 Apr 09Prostatectomy Radicality: Quality of life Cure Continency Avoid additional treatments Potency
NeuroSAFE
Neurovascular Structure Adjacent Frozen-Section Examination
negative margins = positive margins =
nerve sparing no nerve sparingNeuroSAFE
Impact on Nerve Preservation
Staging Nerve Positive
Preservation Surgical
NeuroSAFE 97 % Margins
Control 81 % pT2 99 / 92 7 / 12
Nerve
preservation
all stages
pT3a 94 / 72 21 / 32
pT3b 88 / 40 47 / 51
Schlomm, Eur Urol 2012
Nerve Preservation in:
25.561 Cases in Germany 2012: 32.8 %
Barmer GEK Report 2012: 47.4 %Outcome
Martini-Klinik 2013
n = 2147
600
88.2 %
4.2 %
7.6 %
NeuroSAFE Reduces
Quelle *3: BARMER GEK Krankenhaus Bericht 2012 Radiation Therapy
Quelle *4: Martini-Klinik DatenbankUnique Features
▪ The only European Institution exclusively dedicated to prostate cancer
diagnosis and treatment
▪ Faculty structure
▪ 11 Faculty members perform or train all open and robotic prostatectomies
▪ Martini-Klinik faculty position = life time dedication
▪ High level of specialization
Clinical experience accumulates in the Martini-KlinikFaculty Structure equally ranked, equally paid
What have surgeons and cars in common?
Individual Learning Curve
„High-Volume“ Surgeons
Vickers, JNCI 2007Institutional Learning Curve
Start as
Surgeon
1992
Continence %
2000
1998
2005
2006
2008
Average in Germany 56.7
Barmer GEK Report 2012
40
Accumulated case experienceInternational Consortium of Health Outcomes Measurement
Outcome Measurement Improves Consultation Quality Improves Treatment Quality Preserves Quality of Life Reduces Follow Up Costs Helps to Differentiate to Competitors
Standard Sets for Outcome Measurement www.ichom.org
Every patient needs to know the outcome quality that can be expected prior to the begin of a treatment!
Martinistraße 52
D-20246 Hamburg
Dr. Detlef Loppow Theodor Billroth, 1860
CEO
Tel.: +49 (0) 40 7410-51307 „Soon the time will come when our students and colleagues will
d.loppow@uke.de not be satisfied with general comments about this or that success,
www.uke.de instead they will call each doctor a charlatan who is not able to
express his achievements in figures.”
www.martini-klinik.de
Universitätsklinikum Hamburg-EppendorfYou can also read
