Risk Management Indicators in Patients with Lymphoma in Colombia
Authors: Ramírez Paula , Gil Ana Milena , Fuentes Juan Camilo , Sossa Claudia Lucia , Chalela Claudia Marcela , Sandoval-Sus Jose , Acuña Lizbeth Alexandra 
Published: October 2019

Abstract
Background: Lymphomas are the sixth most common type of cancer in adults in Colombia. According to Cuenta de Alto Costo data from health insurance companies and health providers, there were 10,928 cases (1,257 new cases reported in 2016) of lymphoma in Colombia in 2017. Consequently, it is crucial to develop an instrument to assess and monitor risk management by insurance companies and providers in adults with diagnosis of Hodgkin and non-Hodgkin lymphoma. This would eventually contribute to reduce the impact of the disease in the patients, their families, and the healthcare system. The aim of this study was to establish evidence-based risk management indicators to measure health insurance companies' and health providers' performance in risk control in patients with lymphoma in Colombia.
Methods: A consensus report was conducted adapting the method "The RAND/UCLA Appropriateness Method (RAM)". First, a detailed literature review was performed to synthesize the latest evidence on the topic. Second, a list of indicators was pre-selected. Third, expert panel rated the pre-selected indicators in two rounds. During the first-round, experts answered an online questionnaire to rate each indicator from 1 to 7 using a Likert scale. The ratings were made individually with no interaction among panelists. During the second-round, panelists met and discussed each indicator and the ratings. Then, re-rated each indicator individually. Indicators with a score over 80% were considered consensus. Fourth, a panel meeting was conducted to establish final indicators. And finally, results were shared with all actors involved in the Colombian healthcare system.
Results: Twenty-four insurance companies representatives, 2 government representatives, and a public advocate participated. After reviewing the literature and a panel discussion, experts pre-selected a list of 25 management indicators which then were submitted to online voting. Twenty-three indicators achieved a high score and were validated, but since the two remaining indicators only received an intermediate score, all 25 indicators were submitted to a second online voting after discussing the first-round results. During the second-round, 3 indicators that were rated "inappropriately" by the panelists due to lack of relevance or viability, were conclusively excluded. Lastly, 15 final management indicators were approved and classified in five different domains (diagnosis, staging, treatment, opportunity, and results-overall survival, relapse-free survival, and mortality) during the panel meeting.
Conclusion: Risk management indicators were established by a consensus report to assess and monitor management of patients with lymphoma by insurance companies and health providers. Since management indicators can be assessed from information reported by insurance companies to Cuenta de Alto Costo group, implementing strategies to improve survival rates and health-related quality of life can have great impact decreasing the burden of the disease in the Colombian healthcare system.

Disclosures
No relevant conflicts of interest to declare.