Measuring what matters: using claims data to evaluate healthcare outcomes and volume-outcome relationships

Schepens, M.H.J. (2024)

Doctoral Thesis

Healthcare is under pressure: an ageing population, healthcare-staff shortage, quality (healthcare outcomes) must increase and costs must be reduced.

Yet, what are the outcomes of healthcare?

For some conditions, quality of care is measured for every patient. Unfortunately, this is not the case for prostate cancer and lumbar disk herniation in the Netherlands. We used claims data to evaluate healthcare outcomes and volume-outcome relationships.

Examples of our results:

Prostate cancer:
• More than 30% of patients is incontinent 1 year after radical prostatectomy
• Large differences between hospitals (19%-85%)
• Risk of incontinence is 52% lower at highest-volume hospitals

Lumbar disk herniation:
• One year after hernia surgery, 23% of patients have one or more undesirable outcomes (e.g. re-operation, use of opioids).
• Wide variation in number of operations and outcomes per hospital

Our recommendations:
• Reconsider the disproportionately strict interpretation of the GDPR (AVG) for healthcare research
• Unlock the huge potential of healthcare research based on existing data • Make routine measurement of healthcare outcomes a national standard, for prostate cancer even on a per surgeon level
• Centralization of care should be combined with outcome measurement
• Hospitals should share healthcare outcomes with patients
• Our results urge doctors, health insurers, patient organizations and policymakers to take action

• Healthcare outcomes
• Data reuse
• Value-based healthcare
• Centralization
• Urology
• Prostatectomy
• Incontinence
• Neurosurgery
• Lumbar disk herniation
• Opioids

• All authors: Schepens, M.H.J.
• Supervisor: Wouters, M.W.J.M.; Repping, S.
• Co-supervisor: Hooff, M.L. van
• Committee: Tollenaar, R.A.E.M.; Tromp, S.C.; Poel, H.G. van der; Kramer, M.H.H.
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2024-02-29
• ISBN (print): 9789464697612
• Sponsorship: Financial support for printing of this thesis was kindly provided by Boston Consulting Group, Patiëntenfederatie Nederland, Nictiz, Vektis and Zorgverzekeraars Nederland.