Eindhoven – The time between referral by the GP and the diagnosis of prostate cancer will be four weeks shorter. And the aftercare becomes a lot more efficient. It is a direct result of the Catharina Hospital’s focus on value-driven care.
Prostate cancer
What actually is value-based care? Urologist Robert Hoekstra, the medical leader of the multidisciplinary prostate cancer team, finds it difficult to provide a definition. “But I can say what the key points are for me. The first is patient-oriented work, care tailored to an individual. Secondly, I would like to mention improving care. And value-based care is also about efficiency and costs.” And that is all reflected in the changes that Hoekstra and his team are implementing.
First back to basics; The word prostate cancer does not carry as much meaning for most people as other common forms of cancer. “But in 2022 and 2023, more than 14,000 men were diagnosed with this in the Netherlands. prostate cancer is the most common form of cancer. Every year, 3,000 men die from it, as many deaths as from breast cancer, for example. I think that this less significant burden is because the disease often manifests itself in old age, it is a slow disease and therefore you often grow old with it.”
Balancing act
If there are no metastases, you as a patient can choose a treatment that ensures healing. The options for this are surgery and radiation. The first in particular is a balancing act. “The more you remove from the tumor and the area around it, the greater the chance of some degree of incontinence and erection problems. But the less you remove, the greater the chance that a small part of the tumor will remain. That is a precarious balance.”
In the field of prostate cancer, the Catharina Hospital collaborates with the Canisius Wilhelmina Hospital (CWZ), the Radboud University Medical Center in Nijmegen and Máxima MC in Veldhoven in the Prosper partnership. This has been in place for seven years to better treat the most complex care. “In this way we have obtained an enormous amount of data about diagnostics and surgical results. Every three months we come together as specialists and bare our buttocks. Who has the best results and what can we learn from this doctor?”
Valuable time should not be wasted
The operations are performed by Hoekstra, among others, in the CWZ, everything else is done in the Catharina Hospital. Value-driven care mainly involves optimizing processes. Hoekstra: “When a GP refers you with suspected prostate cancer, an MRI scan is performed to see whether the tumor is present and, if so, how large it is and whether it may be malignant. We then do a biopsy, removing a piece of tissue from the prostate.”
Requesting and analyzing an MRI scan takes time. The same applies to a biopsy. If you only schedule this when the previous step has been completely completed, valuable time will be lost. “For young patients with an increased risk value (PSA value, ed.), we immediately schedule the MRI scan on Monday and the biopsy on Wednesday. The following Monday is the multidisciplinary consultation and the patient will receive the results on Tuesday. This will win us weeks. And with someone who is older and more vulnerable, we take a much more step-by-step approach. Where does he start, does he really want to start the process with the possible complications such as incontinence and erection problems?”
Scrutinize it critically
Patient-oriented work, the best quality care and efficiency all come together. Critically examining costs – all necessary to make healthcare future-proof – is reflected in the protocols for seeing patients who have undergone surgery. “If the patient’s PSA level is 0 after surgery, then everything is fine. Actually a very easy form of control by taking blood. The protocols prescribe that they return for ten years, but if the functions are good after one year, then not much happens after that.”
These men often come to the hospital for a short consultation. Precious time. And so that changed a year ago. “Diagnostics for You, the organization for all first-line diagnostics with a branch in Eindhoven, now takes blood samples. And if the PSA value is not 0, they immediately raise the alarm. If not, it will save us a lot of outpatient visits and the patient a lot of travel time. And this safety net gives urologists more time for complex care.”
Hoekstra sees these innovations as a result of working according to the pillars of value-driven care. “This focus with a ten-person team – consisting of two urologists, a nurse specialist, a radiologist and an oncologist – has actually led to changes. Good for healthcare and good for the patient.”
In addition to prostate cancer, there are 19 other conditions that the Catharina Hospital treats with multidisciplinary teams and the focus of value-driven care. This includes heart failure, various types of cancer, HIV infection, bariatrics (treatment of obesity) and maternity care.
2024-03-10 23:00:00
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