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Nielsen VW, Johansen CB, Todberg T, Skov L, Nissen CV, Dodge R, Egeberg A, Thyssen JP, Thomsen SF. A value-based healthcare model for initiating and switching psoriasis therapies-Results from the prospective multicentre IMPROVE study. J Eur Acad Dermatol Venereol 2024; 38:844-850. [PMID: 38095267 DOI: 10.1111/jdv.19690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 11/08/2023] [Indexed: 04/26/2024]
Abstract
BACKGROUND Little is known about the therapeutic benefits of a value-based healthcare model compared to a traditional activity-based incentive model in psoriasis (PsO). OBJECTIVES This prospective non-interventional study evaluated an outcome-based, patient-centred management model for patients with PsO. METHODS In total, 49 patients with a Psoriasis Area and Severity Index (PASI) ≥3 who were starting or switching between treatments were included. Patients were assessed at baseline, 3 and 9 months. The patient benefit index (PBI) was calculated using predefined questionnaires. An expected PBI was calculated and adjusted for risk factors known to complicate treatment, that is overweight and smoking. The model remunerated the department on whether the observed PBI exceeded the expected PBI to incentivize over-performance. RESULTS In total, 40 patients (80%) completed all three visits; 32.7% were smokers and 73.5% were overweight. Mean PASI at baseline was 11.5 (SD 9.1); PASI improved significantly from baseline through 3 months: mean reduction, 8.0 (SD 9.2), p < 0.001 and was maintained until 9 months: mean further reduction, 0.1 (SD 3.3), p = 0.893. The mean PBI was 2.5 (SD 1.3) and 2.8 (SD 1.1) at 3 and 9 months, respectively. A PBI ≥1 was achieved by 87.8% at 3 and 95.1% at 9 months. Overall, the department was remunerated a mean 2721.1 DKK (SD 4472.8) per patient. In subgroup analysis, the department was remunerated a mean of, respectively, 2428.6 (SD 5089.5), 2636.6 (SD 4471.3) and 3196.5 (SD 4497.1) DKK for patients with none, 1 or 2 risk factors, that is smoking or/and overweight. CONCLUSIONS The model evaluated herein is the first value-based model to calculate remuneration from patient reported outcomes and showed to successfully predict the expected PBI and remunerate treatment based on whether the expected treatment goal was met or exceeded. This can be utilized in the patient-centred management of PsO.
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Affiliation(s)
- V W Nielsen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - C B Johansen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T Todberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - C V Nissen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - R Dodge
- Novartis Healthcare A/S, Copenhagen, Denmark
| | - A Egeberg
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - J P Thyssen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - S F Thomsen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Wolf A, Erichsen Andersson A, Wikström E, Bååthe F. Untangling the perception of value in value-based healthcare - an interview study. Leadersh Health Serv (Bradf Engl) 2024; 37:130-141. [PMID: 38635293 DOI: 10.1108/lhs-07-2023-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
PURPOSE Value-based health care (VBHC) argues that health-care needs to re-focus to maximise value creation, defining value as the quota when dividing the outcomes important for the patient, by the cost for health care to deliver such outcomes. This study aims to explore the perception of value among different stakeholders involved in the process of implementing VBHC at a Swedish hospital to support leaders to be more efficient and effective when developing health care. DESIGN/METHODOLOGY/APPROACH Participants comprised 19 clinicians and non-clinicians involved in the implementation of VBHC. Semi-structured interviews were conducted and content analysis was performed. FINDINGS The clinicians described value as a dynamic concept, dependent on the patient and the clinical setting, stating that improving outcomes was more important than containing costs. The value for non-clinicians appeared more driven by the interplay between the outcome and the cost. Non-clinicians related VBHC to a strategic framework for governance or for monitoring different continuous improvement processes, while clinicians appreciated VBHC, as they perceived its introduction as an opportunity to focus more on outcomes for patients and less on cost containment. ORIGINALITY/VALUE There is variation in how clinicians and non-clinicians perceive the key concept of value when implementing VBHC. Clinicians focus on increasing treatment efficacy and improving medical outcomes but have a limited focus on cost and what patients consider most valuable. If the concept of value is defined primarily by clinicians' own assumptions, there is a clear risk that the foundational premise of VBHC, to understand what outcomes patients value in their specific situation in relation to the cost to produce such outcome, will fail. Health-care leaders need to ensure that patients and the non-clinicians' perception of value, is integrated with the clinical perception, if VBHC is to deliver on its promise.
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Affiliation(s)
- Axel Wolf
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden and Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Annette Erichsen Andersson
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden and Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ewa Wikström
- Department of Business Administration, School of Business, Economics and Law, University of Gothenburg, Gothenburg, Sweden, and
| | - Fredrik Bååthe
- Institute for Studies of the Medical Profession, LEFO, Oslo, Norway; Institute of Stress Medicine at Region Västra Götaland, Gothenburg, Sweden and Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Skinner THJ. From integrated care to value-based healthcare in New South Wales. AUST HEALTH REV 2024; 48:AH24018. [PMID: 38573782 DOI: 10.1071/ah24018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 04/06/2024]
Affiliation(s)
- The Hon Jillian Skinner
- Ngunnawal Country, Australian Healthcare & Hospitals Association, Unit 8, 2 Phipps Close, Deakin, ACT 2600, Australia
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Almasoud NF, Aldosari MA, Mahmoud AS, Alendijani YA, Alkhenizan AH. Inappropriate laboratory test utilization in outpatient tertiary care: Implications for value-based healthcare. Saudi Med J 2024; 45:356-361. [PMID: 38657991 DOI: 10.15537/smj.2024.45.4.20230512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/16/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES To assess the rate of inappropriate repetition of laboratory testing and estimate the cost of such testing for thyroid stimulating hormone (TSH), total cholesterol, vitamin D, and vitamin B12 tests. METHODS A retrospective cohort study was carried out in the Family Medicine and Polyclinic Department at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. Clinical and laboratory data were collected between 2018-2021 for the 4 laboratory tests. The inappropriate repetition of tests was defined according to international guidelines and the costs were calculated using the hospital prices. RESULTS A total of 109,929 laboratory tests carried out on 23,280 patients were included in this study. The percentage of inappropriate tests, as per the study criteria, was estimated to be 6.1% of all repeated tests. Additionally, the estimated total cost wasted amounted to 2,364,410 Saudi Riyals. Age exhibited a weak positive correlation with the total number of inappropriate tests (r=0.196, p=0.001). Furthermore, significant differences were observed in the medians of the total number of inappropriate tests among genders and nationalities (p<0.001). CONCLUSION The study identified significantly high rates of inadequate repetitions of frequently requested laboratory tests. Urgent action is therefore crucial to overcoming such an issue.
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Affiliation(s)
- Nouf F Almasoud
- From the Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed A Aldosari
- From the Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed S Mahmoud
- From the Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Yaser A Alendijani
- From the Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah H Alkhenizan
- From the Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
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Newton D, Bader AM. Value-Based Health Care in Perioperative Medicine: Process Maps and Costing to Determine Best Practices. Anesthesiol Clin 2024; 42:75-86. [PMID: 38278594 DOI: 10.1016/j.anclin.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Perioperative care in the United States is largely based on current fee-for-service models. Fee-for-service models are not based on the true cost of services provided, charges do not equal costs, and reimbursement varies based on insurer. Value-based health care is defined as patient-centered outcomes over cost of providing these services. Process mapping and time-driven activity-based costing can be used to define actual cost of services provided. Outcomes after discharge can be measured, so that the overall value of care provided can be assessed and improved based on the outcomes and costs identified.
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Affiliation(s)
- David Newton
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Angela M Bader
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Abubakar Z, Sjaaf AC, Gondhowiardjo TD, Giffari Makkaraka MA. Implementation of value-based healthcare in ophthalmology: a scoping review. BMJ Open Ophthalmol 2024; 9:e001654. [PMID: 38429068 PMCID: PMC10910640 DOI: 10.1136/bmjophth-2024-001654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE This review aimed to identify and summarise how value-based healthcare (VBHC) is implemented in the field of ophthalmology. METHODS A scoping review was conducted by searching empirical and non-empirical articles from from electronic databases (PubMed, Science Direct, ProQuest and Scopus) and other methods starting January 2006 (the year Porter and Teisberg introduced VBHC) up to 31 December 2023. RESULTS 1.081 records were screened, and 12 articles (8 empirical studies and 4 non-empirical articles) were used for data extraction. Most articles were published in the UK. Most articles described the implementation of VBHC agenda by measuring outcomes and costs. All the included empirical studies reported implementation effect; otherwise, non-empirical articles were only described proposed implementation. CONCLUSION The implementation of VBHC in ophthalmology has shown a positive impact on enhancing patient value and reducing healthcare costs. Nevertheless, the study highlighted that no provider or healthcare system has fully embraced and implemented VBHC, comprehensively addressing the entire value agenda.
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Affiliation(s)
- Zulkarnain Abubakar
- Doctoral Program in Public Health, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Amal Chalik Sjaaf
- Department of Administration & Health Policy, Universitas Indonesia, Depok, Indonesia
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Derks TGJ, Venema A, Köller C, Bos E, Overduin RJ, Stolwijk NN, Hofbauer P, Bolhuis MS, van Eenennaam F, Groen H, Hollak CEM, Wortmann SB. Repurposing empagliflozin in individuals with glycogen storage disease Ib: A value-based healthcare approach and systematic benefit-risk assessment. J Inherit Metab Dis 2024; 47:244-254. [PMID: 38185897 DOI: 10.1002/jimd.12714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024]
Abstract
Off-label repurposing of empagliflozin allows pathomechanism-based treatment of neutropenia/neutrophil-dysfunction in glycogen storage disease type Ib (GSDIb). From a value-based healthcare (VBHC) perspective, we here retrospectively studied patient-reported, clinical and pharmacoeconomic outcomes in 11 GSDIb individuals before and under empagliflozin at two centers (the Netherlands [NL], Austria [AT]), including a budget impact analysis, sensitivity-analysis, and systematic benefit-risk assessment. Under empagliflozin, all GSDIb individuals reported improved quality-of-life-scores. Neutrophil dysfunction related symptoms allowed either granulocyte colony-stimulating factor cessation or tapering. Calculated cost savings per patient per year ranged between € 6482-14 190 (NL) and € 1281-41 231 (AT). The budget impact analysis estimated annual total cost savings ranging between € 75 062-225 716 (NL) and € 37 697-231 790 (AT), based on conservative assumptions. The systematic benefit-risk assessment was favorable. From a VBHC perspective, empagliflozin treatment in GSDIb improved personal and clinical outcomes while saving costs, thereby creating value at multiple pillars. We emphasize the importance to reimburse empagliflozin for GSDIb individuals, further supported by the favorable systematic benefit-risk assessment. These observations in similar directions in two countries/health care systems strongly suggest that our findings can be extrapolated to other geographical areas and health care systems.
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Affiliation(s)
- Terry G J Derks
- Department of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Annieke Venema
- Department of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clara Köller
- University Children's Hospital, Salzburger Landeskliniken (SALK), Paracelsus Medical University (PMU), Salzburg, Austria
| | - Eline Bos
- Department of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ruben J Overduin
- Department of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nina N Stolwijk
- Medicine for Society, Platform at Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Hofbauer
- Department of Production, Landesapotheke Salzburg, Hospital Pharmacy, Salzburg, Austria
| | - Mathieu S Bolhuis
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Fred van Eenennaam
- The Decision Group, Amsterdam, The Netherlands
- Erasmus School of Accounting & Assurance, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, Groningen, The Netherlands
| | - Carla E M Hollak
- Medicine for Society, Platform at Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Saskia B Wortmann
- University Children's Hospital, Salzburger Landeskliniken (SALK), Paracelsus Medical University (PMU), Salzburg, Austria
- Department of Pediatrics, Amalia Children's Hospital, Nijmegen, The Netherlands
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Hegde S, McKee S, Cole D, Wainer Z. Experiences and learnings from developing and implementing a co-designed value-based healthcare framework within Victorian public oral health sector. AUST HEALTH REV 2024; 48:AH24017. [PMID: 38537306 DOI: 10.1071/ah24017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/29/2024] [Indexed: 04/05/2024]
Abstract
Objective This study aimed to describe the development and implementation of a co-designed value-based healthcare (VBHC) framework within the public dental sector in Victoria. Methods A mixed-method study was employed. Explorative qualitative design was used to examine patient, workforce and stakeholder perspectives of implementing VBHC. Participatory action research was used to bring together qualitative narrative-based research and service design methods. An experience-based co-design approach was used to enable staff and patients to co-design services. Quantitative data was sourced from Titanium (online patient management system). Results Building a case for VBHC implementation required intensive work. It included co-designing, collaborating, planning and designing services based on patient needs. Evidence reviews, value-stream mapping and development of patient reported outcomes (PROMs) and patient reported experience measures (PREMs) were fundamental to VBHC implementation. Following VBHC implementation, a 44% lower failure to attend rate and 60% increase in preventive interventions was reported. A higher proportion of clinicians worked across their top scope of practice within a multi-disciplinary team. Approximately 80% of services previously provided by dentists were shifted to oral health therapists and dental assistants, thereby releasing the capacity of dentists to undertake complex treatments. Patients completed baseline International Consortium for Health Outcomes Measurement PROMs (n = 44,408), which have been used for social/clinical triaging, determining urgency of care based on risk, segmentation and tracking health outcomes. Following their care, patients completed a PREMs questionnaire (n = 15,402). Patients agreed or strongly agreed that: the care they received met their needs (87%); they received clear answers to their questions (93%); they left their visit knowing what is next (91%); they felt taken care of during their visit (94%); and they felt involved in their treatment and care (94%). Conclusion The potential for health system transformation through implementation of VBHC is significant, however, its implementation needs to extend beyond organisational approaches and focus on sustaining the principles of VBHC across healthcare systems, policy and practice.
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Affiliation(s)
- Shalika Hegde
- Dental Health Services Victoria, Melbourne, Vic., Australia
| | - Susan McKee
- Dental Health Services Victoria, Melbourne, Vic., Australia
| | | | - Zoe Wainer
- Department of Health Victoria, Melbourne, Vic., Australia
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Gavaghan B, Finch J, Clarke K. Creating a framework for change: transitioning to value-based healthcare in Queensland. AUST HEALTH REV 2024; 48:AH24001. [PMID: 38522434 DOI: 10.1071/ah24001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024]
Abstract
Value-based healthcare has been described as the sustainable, equitable and transparent use of healthcare resources to achieve improved experiences and outcomes for people and communities. It is supported by all levels of government in Australia, with recent initiatives championing a shift away from traditional, clinician-centric care delivery to a more contemporary, value-based approach. To date, however, efforts in Queensland have focused on smaller scale siloed models of care and have not extended to the transformational change required to create equitable and sustainable healthcare delivery. The Queensland Health Allied Health Framework for Value-Based Health Care (the Framework) builds on contemporary frameworks with reference to the local context in Queensland and provides a structure and starting point for clinicians and managers to work together with consumers to transform services to focus on preventative health and wellbeing, shifting the focus of care to the community and sustainably improving the quality of care delivered. The Framework outlines key considerations for the design and implementation of new services, including understanding the care pathway, supporting an outcome driven workplace culture, measuring what matters and designing for outcomes. Several key lessons were learnt during the development of the Framework, including the importance of early and sustained consumer partnerships, of establishing a shared definition of value-based healthcare that enables integration across the care pathway and the need for leadership at all levels to actively support the change management process. While developed for Queensland public allied health services, the Framework is intended to be a system-wide tool relevant to all health professionals and services.
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Wellington M, Whiting E, Searle D, Kreis M, Cross E. Driving value-based healthcare through a new vision for Queensland's health system. AUST HEALTH REV 2024; 48:AH24002. [PMID: 38493763 DOI: 10.1071/ah24002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/27/2024] [Indexed: 03/19/2024]
Abstract
The purpose of this case study is to explain the development of Queensland's strategic approach to health system reform, which promotes partnership across the health system to better deliver integrated and value-based health care across the continuum of care. The new health system vision was informed by undertaking literature searches on national and international health system approaches to reform and supported by extensive consultation across Queensland with more than 1100 stakeholders. Thematic analysis was undertaken to identify key themes that were translated into a high-level vision document that communicated Queensland's renewed focus on wellness and delivering more care in the community. This was circulated to stakeholders for iterative and collaborative refinement before final approvals. Collaboratively and iteratively developing the new health system vision for Queensland with key stakeholders has contributed to a shared understanding and ownership of a vision that is committed to system reform, focused on delivering high-value care that reflects what is important to consumers and health system stakeholders.
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Affiliation(s)
- Madeleine Wellington
- Reform Office, Strategy, Policy and Reform Division, Queensland Health, 33 Charlotte Street, Brisbane, Qld 4000, Australia
| | - Elizabeth Whiting
- Reform Office, Strategy, Policy and Reform Division, Queensland Health, 33 Charlotte Street, Brisbane, Qld 4000, Australia; and Department of Medicine, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, Qld 4032, Australia; and Faculty of Medicine, University of Queensland, St Lucia, Brisbane, Qld 4067, Australia
| | - Damien Searle
- Reform Office, Strategy, Policy and Reform Division, Queensland Health, 33 Charlotte Street, Brisbane, Qld 4000, Australia
| | - Megan Kreis
- Reform Office, Strategy, Policy and Reform Division, Queensland Health, 33 Charlotte Street, Brisbane, Qld 4000, Australia
| | - Emily Cross
- Reform Office, Strategy, Policy and Reform Division, Queensland Health, 33 Charlotte Street, Brisbane, Qld 4000, Australia
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Harrison R, Ellis LA, Sina M, Walsan R, Mitchell R, Walpola R, Maberly G, Chan C, Hay L. Measuring clinician experience in value-based healthcare initiatives: a 10-item core clinician experience measure (CEM-10). AUST HEALTH REV 2024; 48:AH24003. [PMID: 38467113 DOI: 10.1071/ah24003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
Objective Clinician's experiences of providing care are identified as a key outcome associated with value-based healthcare (VBHC). In contrast to patient-reported experience measures, measurement tools to capture clinician's experiences in relation to VBHC initiatives have received limited attention to date. Progressing from an initial 18-item clinician experience measure (CEM), we sought to develop and evaluate the reliability of a set of 10 core clinician experience measure items in the CEM-10. Methods A multi-method project was conducted using a consensus workshop with clinicians from a range of NSW Health local health districts to reduce the 18-item CEM to a short form 10-item core clinician experience measure (CEM-10). The CEM-10 was deployed with clinicians providing diabetes care, care for older adults and virtual care across all districts and care settings of New South Wales, Australia. Psychometric analysis was used to determine the internal consistency of the tool and its suitability for diverse clinical contexts. Results Consensus building sessions led to a rationalised 10-item tool, retaining the four domains of psychological safety (two items), quality of care (three items), clinician engagement (three items) and interprofessional collaboration (two items). Data from four clinician cohorts (n = 1029) demonstrated that the CEM-10 four-factor model produced a good fit to the data and high levels of reliability, with factor loadings ranging from 0.77 to 0.92, with Cronbach's alpha (range: 0.79-0.90) and composite reliability (range: 0.80-0.92). Conclusions The CEM-10 provides a core set of common clinician experience measurement items that can be used to compare clinician's experiences of providing care between and within cohorts. The CEM-10 may be supported by additional items relevant to particular initiatives when evaluating VBHC outcomes.
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Affiliation(s)
- Reema Harrison
- Centre for Health Systems and Safety, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2109, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2109, Australia
| | - Maryam Sina
- Centre for Health Systems and Safety, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2109, Australia
| | - Ramya Walsan
- Centre for Health Systems and Safety, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2109, Australia
| | - Rebecca Mitchell
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2109, Australia
| | - Ramesh Walpola
- School of Health Sciences, University of New South Wales, NSW 2052, Australia
| | - Glen Maberly
- Western Sydney Diabetes, Blacktown and Western Sydney Local Health District, NSW 2151, Australia
| | - Catherine Chan
- Strategic Reform Branch, NSW Ministry of Health, Sydney, NSW 2065, Australia
| | - Liz Hay
- Strategic Reform Branch, NSW Ministry of Health, Sydney, NSW 2065, Australia
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Westerink HJ, Steinmann G, Koomans M, van der Kemp MH, van der Nat PB. Value-based healthcare implementation in the Netherlands: a quantitative analysis of multidisciplinary team performance. BMC Health Serv Res 2024; 24:224. [PMID: 38383368 PMCID: PMC10882801 DOI: 10.1186/s12913-024-10712-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/13/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Many hospitals worldwide have set up multidisciplinary Value Improvement (VI) teams that use the Value-Based Health Care (VBHC) theory to improve patient value. However, it remains unclear what the level of VBHC implementation is within these teams. We therefore studied the current level of VBHC implementation in VI teams. METHODS A questionnaire was developed based on the strategic agenda for value transformation and real-world experiences with VBHC implementation. The questionnaire consisted of 21 questions, mapped to seven domains, and was sent out to 25 multidisciplinary VI teams. Median scores for individual questions (scale = 1-5) and average scores per domain were calculated. RESULTS One hundred forty VI team members completed the questionnaire. The overall average score is 3.49. The 'culture and responsibility' domain obtained the highest average score (µ = 4.11). The domain 'measure and improve outcomes' and the domain 'multidisciplinary team' obtained average scores that are slightly higher than the overall average (µ = 3.78 and µ = 3.76 respectively), and the domains 'strategy and organizational policy,' 'collaboration and sharing,' and 'IT and data' scored a little below the overall average (µ = 3.41, µ = 3.32, and µ = 3.29 respectively). The domain 'costs and reimbursement' obtained the lowest average score (µ = 2.42) of all domains, indicating that the implementation of this particular aspect of VBHC remains lagging behind. CONCLUSIONS Our results indicate activity in each of the questionnaire domains. To bring VBHC implementation to the next level, more attention should be given to the financial aspects. Our questionnaire can be used in future studies to identify improvements or differences within VI teams.
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Affiliation(s)
- Henrike J Westerink
- Department of Value Improvement, St. Antonius Hospital, Koekoekslaan 1, 3430EM Nieuwegein, Nieuwegein, 3430 EM, the Netherlands.
- Scientific Center for Quality of Healthcare (IQ Health), Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, the Netherlands.
| | - Gijs Steinmann
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Maarten Koomans
- Working group 'Integrated Practice Units', Linnean, Zeist, the Netherlands
| | | | - Paul B van der Nat
- Department of Value Improvement, St. Antonius Hospital, Koekoekslaan 1, 3430EM Nieuwegein, Nieuwegein, 3430 EM, the Netherlands
- Scientific Center for Quality of Healthcare (IQ Health), Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, the Netherlands
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Bernstein DN, Jayakumar P, Bozic KJ. Value-based Healthcare: Cost Containment Does Not Equal Value Creation. Clin Orthop Relat Res 2024; 482:239-240. [PMID: 38133497 PMCID: PMC10776140 DOI: 10.1097/corr.0000000000002963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Affiliation(s)
- David N. Bernstein
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
| | - Prakash Jayakumar
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Kevin J. Bozic
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
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Fernández-Salido M, Alhambra-Borrás T, Casanova G, Garcés-Ferrer J. Value-Based Healthcare Delivery: A Scoping Review. Int J Environ Res Public Health 2024; 21:134. [PMID: 38397625 PMCID: PMC10888410 DOI: 10.3390/ijerph21020134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
Healthcare systems are transforming from the traditional volume-based model of healthcare to a value-based model of healthcare. Value generation in healthcare is about emphasising the health outcomes achieved by patients and organisations while maintaining an optimal relationship with costs. This scoping review aimed to identify the key elements and outcomes of implementing value-based healthcare (VBHC). The review process included studies published from 2013 to 2023 in four different databases (SpringerLink, PubMed, ProQuest and Scopus). Of the 2801 articles retrieved from the searches, 12 met the study's inclusion criteria. A total of 11 studies referred to value as the relationship between the outcomes achieved by patients and the costs of achieving those outcomes. Most of the studies highlighted the presence of leadership, the organisation of care into integrated care units, the identification and standardisation of outcome measures that generate value for the patient, and the inclusion of the patient perspective as the most prominent key elements for optimal VBHC implementation. Furthermore, some benefits were identified from VBHC implementation, which could shed light for future implementation actions. Therefore, the VBHC model is a promising approach that may contribute to an improvement in the efficiency and sustainability of healthcare.
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Affiliation(s)
- Mirian Fernández-Salido
- Instituto de Investigación en Políticas de Bienestar Social (POLIBIENESTAR)—Research Institute on Social Welfare Policy, Universitat de València, 46022 Valencia, Spain; (T.A.B.); (J.G.F.)
| | - Tamara Alhambra-Borrás
- Instituto de Investigación en Políticas de Bienestar Social (POLIBIENESTAR)—Research Institute on Social Welfare Policy, Universitat de València, 46022 Valencia, Spain; (T.A.B.); (J.G.F.)
| | - Georgia Casanova
- Centre for Socio-Economic Research on Ageing, IRCCS-INRCA National Institute of Health & Science on Ageing, 60124 Ancona, Italy;
| | - Jorge Garcés-Ferrer
- Instituto de Investigación en Políticas de Bienestar Social (POLIBIENESTAR)—Research Institute on Social Welfare Policy, Universitat de València, 46022 Valencia, Spain; (T.A.B.); (J.G.F.)
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Carbone M, Neuberger J, Rowe I, Polak WG, Forsberg A, Fondevila C, Mantovani L, Nardi A, Colli A, Rockell K, Schick L, Cristoferi L, Oniscu GC, Strazzabosco M, Cillo U. European Society for Organ Transplantation (ESOT) Consensus Statement on Outcome Measures in Liver Transplantation According to Value-Based Health Care. Transpl Int 2024; 36:12190. [PMID: 38332850 PMCID: PMC10850237 DOI: 10.3389/ti.2023.12190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/14/2023] [Indexed: 02/10/2024]
Abstract
Liver transplantation is a highly complex, life-saving, treatment for many patients with advanced liver disease. Liver transplantation requires multidisciplinary teams, system-wide adaptations and significant investment, as well as being an expensive treatment. Several metrics have been proposed to monitor processes and outcomes, however these lack patient focus and do not capture all aspects of the process. Most of the reported outcomes do not capture those outcomes that matter to the patients. Adopting the principles of Value-Based Health Care (VBHC), may provide an opportunity to develop those metrics that matter to patients. In this article, we present a Consensus Statement on Outcome Measures in Liver Transplantation following the principles of VBHC, developed by a dedicated panel of experts under the auspices of the European Society of Organ Transplantation (ESOT) Guidelines' Taskforce. The overarching goal is to provide a framework to facilitate the development of outcome measures as an initial step to apply the VMC paradigm to liver transplantation.
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Affiliation(s)
- Marco Carbone
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Liver Unit, ASST Grande Ospedale Metropolitano (GOM) Niguarda, Milan, Italy
| | - James Neuberger
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Ian Rowe
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Wojciech G. Polak
- Erasmus MC Transplant Institute, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Anna Forsberg
- Institute of Health Sciences, Lund University, Lund, Sweden
| | | | - Lorenzo Mantovani
- Center for Study and Research on Public Health, University of Milan-Bicocca, Milan, Italy
| | - Alessandra Nardi
- Department of Mathematics, University of Rome Tor Vergata, Rome, Italy
| | - Agostino Colli
- Istituto di Ricovero e Cura a Carattere Scientifico, Ca’ Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | | | - Liz Schick
- World Transplant Games Federation, Winchester, United Kingdom
| | - Laura Cristoferi
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Gabriel C. Oniscu
- Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Mario Strazzabosco
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, United States
| | - Umberto Cillo
- Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine and Surgery, University of Padua, Padua, Italy
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Lee RA, Masic S, Bland J, Handorf E, Kutikov A, Esnaola N, Farma J, Su S, Ridge JA, Chu C, Patel S, Curcillo P, Helstrom JL, Uzzo RG. Transition to Value-based Healthcare: Development, Implementation, and Results of an Optimal Surgical Care Framework at a National Cancer Institute-designated Comprehensive Cancer Center. Eur Urol Focus 2024; 10:123-130. [PMID: 37648597 DOI: 10.1016/j.euf.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/08/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND The continued rise in healthcare expenditures has not produced commensurate improvements in patient outcomes, leading US healthcare stakeholders to emphasize value-based care. Transition to such a model requires all team members to adopt a new strategic and organizational framework. OBJECTIVE To describe and report a strategy for the implementation of a novel patient-centered value-based "optimal surgical care" (OSC) framework, with validation and cost analysis in kidney surgery. DESIGN, SETTING, AND PARTICIPANTS An observational study of care episodes at a single institution from 2014 to 2019 was conducted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multidisciplinary teams defined OSC by core and procedure-specific metrics using a combination of provider-based ("bottom-up") and "clinical leadership"-based ("top-down") strategies. Baseline OSC rates across were established, while identifying proportions of OSC achieved by coefficient of variation (CV) in total direct costs. Multivariable linear regression comparing cost between OSC and non-OSC encounters was performed, adjusting for patient characteristics. RESULTS AND LIMITATIONS An analysis of 30 261 perioperative care episodes was performed. Following the implementation of an OSC framework, there was an increase in OSC rates across all procedure buckets using core (25%) and procedure-specific (26%) metrics. Among the tumors tested, kidney cancer surgical episodes held the highest OSC rate improvement (67%) with lowest variability in cost (CV 0.5). OSC was associated with significant total cost savings across all tumor types after adjusting for inflation (p < 0.05). Compared with non-OSC episodes, a significant reduction in the cost ratio of OSC was noted for renal surgery (p < 0.01), with estimated costs savings of $2445.87 per OSC encounter. CONCLUSIONS Institutional change directing efforts toward optimizing surgical care and emphasizing value rather than focusing solely on expense reduction is associated with improved outcomes, while potentially reducing costs. The strategy for implementation requires serial performance analyses, engaging and educating providers, and continuous ongoing adjustments to achieve durable results. PATIENT SUMMARY In this study, we report our strategy and outcomes for transitioning to a value-based healthcare model using a novel "optimal surgical care" framework at a National Cancer Institute-designated comprehensive cancer center. We observed an increase in optimal surgical care episodes across all specialties after 5 yr, with a potential associated reduction in cost expenditure. We conclude that the key to a successful and sustained transition is the implementation strategy, focusing on continual review and provider engagement.
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Affiliation(s)
- Randall A Lee
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
| | - Selma Masic
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Joseph Bland
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Elizabeth Handorf
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Alexander Kutikov
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Nestor Esnaola
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jeffrey Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Stacey Su
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - John A Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Christina Chu
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Sameer Patel
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Paul Curcillo
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - James L Helstrom
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Robert G Uzzo
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
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Vegter L, Klaasen NG, Kreuger L, van den Berg KS, van der Nat PB, Hegeman JM. [Value-based healthcare in mental health care: a practical example]. Tijdschr Psychiatr 2024; 66:36-41. [PMID: 38380486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
BACKGROUND To promote quality improvement in Dutch mental health care, it is imperative to line up methods of quality improvement with daily care practice. In value-based healthcare the joint vision of medical professionals and patients is leading in the design and execution of care improvements. AIM To demonstrate the value of value-based care. METHOD Description of a practical example of the application of value based healthcare in mental healthcare, including a practical example of value-based improvement of patient care. RESULTS A multidisciplinary improvement team was formed, consisting of patients and employees who were involved in the depression care pathway. The team determined important outcomes of care from the patient’s perspective, and successfully executed several improvement initiatives. CONCLUSION The bottom-up approach of value-based healthcare is in line with day-to-day care practice and provides opportunities for effectively improving the quality of mental health care.
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Bogach J, Maciver A, Francescutti VA. Value-Based Health Care: The Fine Balance of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS ± HIPEC). Ann Surg Oncol 2023; 30:7926-7928. [PMID: 37782410 DOI: 10.1245/s10434-023-14303-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Jessica Bogach
- Division of General Surgery, Department of Surgery, Juravinski Hospital and Cancer Center and McMaster University, Hamilton, ON, Canada
| | - Allison Maciver
- Divisions of General Surgery and Surgical Oncology, Western University, London Health Sciences Centre, London, ON, Canada
| | - Valerie A Francescutti
- Division of General Surgery, Department of Surgery, Juravinski Hospital and Cancer Center and McMaster University, Hamilton, ON, Canada.
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Smith PC, Sagan A, Siciliani L, Figueras J. Building on value-based health care: Towards a health system perspective. Health Policy 2023; 138:104918. [PMID: 37797445 DOI: 10.1016/j.healthpol.2023.104918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
A variety of methodologies have been developed to help health systems increase the 'value' created from their available resources. The urgency of creating value is heightened by population ageing, growth in people with complex morbidities, technology advancements, and increased citizen expectations. This study develops a policy framework that seeks to reconcile the various approaches towards value-based policies in health systems. The distinctive contribution is that we focus on the value created by the health system as a whole, including health promotion, thus moving from value-based health care towards a value-based health system perspective. We define health system value to be the contribution of the health system to societal wellbeing. We adopt a framework of five dimensions of value, embracing health improvement, health care responsiveness, financial protection, efficiency and equity, which we map onto a society's aggregate wellbeing. Actors within the health system make different contributions to value, and we argue that their perspectives can be aligned with a unifying concept of health system value. We provide examples of policy levers and highlight key actors and how they can promote certain aspects of health system value. We discuss advantages of value-based approach based on the notion of wellbeing and some practical obstacles to its implementation.
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Affiliation(s)
- Peter C Smith
- Imperial College London, Business School, London, United Kingdom
| | - Anna Sagan
- European Observatory on Health Systems and Policies, London, United Kingdom
| | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, York, United Kingdom.
| | - Josep Figueras
- European Observatory of Health Systems and Policies, Brussels, Belgium
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Torkki P, Leskelä RL, Mustonen P, Linna M, Lillrank P. How to extend value-based healthcare to population-based healthcare systems? Defining an outcome-based segmentation model for health authority. BMJ Open 2023; 13:e077250. [PMID: 37968009 PMCID: PMC10660826 DOI: 10.1136/bmjopen-2023-077250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVES Value-based healthcare (VBHC) is considered the most promising guiding principle for a new generation of health service production. Many countries have attempted to apply VBHC to managerial and clinical decision-making. However, implementation remains in its infancy and varies between countries. The objective of the study is to help health systems implement a value-based approach by building an outcome-based population segmentation model for health authorities (HAs). DESIGN First, we define the principles according to which segmentation models in healthcare could be developed. Second, we merge the theoretical characteristics of outcomes with population segmentation dimensions identified in previous literature and design a flow model that establishes population segments from these combinations. We then estimate the size of the segments based on national register data. RESULTS The population can be divided into 10 different segments based on relevant outcomes, goals and the outcome measurement logic. These segments consist of healthy, help, increased risk, mild curable without risk, mild curable with risk, severe curable without risk, severe curable with risk, single chronic, multimorbid and terminal. The representatives of Finnish HAs found the segments meaningful for evaluating and managing the healthcare system towards improved population health. CONCLUSIONS An outcome-based segmentation model for the entire population is needed if an HA wants to steer the healthcare system employing the principles of VBHC. Segmentation should be based on the outcome measurement logic and outcome measurements relevant to each segment and the number of segments has to be limited.
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Affiliation(s)
- Paulus Torkki
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Riikka-Leena Leskelä
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Nordic Healthcare Group Ltd, Helsinki, Finland
| | | | - Miika Linna
- Department of Industrial Engineering and Management, Aalto University, Aalto, Finland
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Paul Lillrank
- Department of Industrial Engineering and Management, Aalto University, Aalto, Finland
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Pecoraro V, Fasano T, Aspromonte N, Barocci S, Bartolucci D, Clerico A, Gallucci F, Gnerre P, Lo Sasso B, Mariottini A, Medea G, Perrone MA, Ruscio M, Sciacovelli L, Trenti T, Chiani V, Paolini D, Banfi G. The role of laboratory medicine in a value-based healthcare system: the example of heart failure patient management in the Italian context. Eur Rev Med Pharmacol Sci 2023; 27:10763-10772. [PMID: 37975401 DOI: 10.26355/eurrev_202311_34356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE As of today, healthcare systems worldwide face severe challenges that undermine their sustainability. The value-based healthcare (VBHC) approach has been proposed as a strategic and methodological framework to ensure the delivery of the best patient outcomes with economic efficiency. Through the illustrative example of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) for heart failure (HF) patient management in the context of the Italian National Healthcare system, this article explores the role that in vitro diagnostics (IVDs) can play in enabling value-based care models. SUBJECTS AND METHODS 14 healthcare professionals representing the relevant professional figures involved in HF patient management met to revise the current HF patient journey and design a new care pathway that, leveraging on BNP/NT-proBNP, reflects the VBHC principles. RESULTS The literature recognizes the dosage of BNP/NT-proBNP as the gold stan-dard for diagnosing HF. However, as of today, these IVDs are not employed at their full potential regarding HF patient management. A new patient journey is proposed so that patients are diagnosed early and properly monitored in the aftermath of hospitalization, improving outcomes at contained costs. CONCLUSIONS As testified by the example of HF patient management in Italy, laboratory medicine can represent a lever for adopting value-based care models. Still, large-scale adoption of VBHC will call for structural reforms that revise how healthcare delivery is organized, measured, and reimbursed.
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Affiliation(s)
- V Pecoraro
- Department of Laboratory Medicine and Pathology, Azienda Unità Sanitaria Locale di Modena, Modena, Italy.
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Jayakumar P, Oude Nijhuis KD, Oosterhoff JHF, Bozic KJ. Value-based Healthcare: Can Generative Artificial Intelligence and Large Language Models be a Catalyst for Value-based Healthcare? Clin Orthop Relat Res 2023; 481:1890-1894. [PMID: 37678399 PMCID: PMC10499068 DOI: 10.1097/corr.0000000000002854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Prakash Jayakumar
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Koen D. Oude Nijhuis
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
- Department of Orthopedic Surgery, The University of Groningen, Groningen, the Netherlands
| | - Jacobien H. F. Oosterhoff
- Department of Engineering Systems and Services, Faculty Technology Policy and Management, Delft University of Technology, Delft, the Netherlands
| | - Kevin J. Bozic
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
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Shvets YY. [Applying robust management approaches to transit to value-based healthcare]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2023; 31:1176-1182. [PMID: 38069882 DOI: 10.32687/0869-866x-2023-31-s2-1176-1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/05/2023] [Indexed: 12/18/2023]
Abstract
Health systems require continuous improvement. Along with that, despite the pace of the society development, they face a number of global problems, which can be solved by the transition to value-based healthcare through robust management. The purpose of the study is to analyze the relationship between sustainable healthcare management and life expectancy in the regions of the Russian Federation, with a special focus on the impact of robust management factors on this indicator. The study used theoretical methods: observation, measurement, comparison, analysis, modeling, synthesis, study and generalization, as well as practical ones: modeling using Pandas, Numpy, Scipy, Geopandas, Sklearn, Matplotlib and Seaborn packages for the Python programming language. The study resulted in the construction of a tree-like model of the relationship of indicators, which made it possible to obtain a multi-level list with the mutual influence of factors and thresholds. By examining the dynamics in the relationship between health management strategies and life expectancy across regions, we sought to identify key control factors that can be used to improve health outcomes across the country and assess which ones have more and less impact. The result of the analysis was the determination of the threshold values of indicators, the change in which leads to a significant change in life expectancy.
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Affiliation(s)
- Yu Yu Shvets
- Research Institute for Healthcare Organization and Medical Management, 115088, Moscow, Russia,
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van Staalduinen DJ, van den Bekerom PE, Groeneveld SM, Stiggelbout AM, van den Akker-van Marle ME. Relational coordination in value-based health care. Health Care Manage Rev 2023; 48:334-341. [PMID: 37615943 PMCID: PMC10476589 DOI: 10.1097/hmr.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND An important element of value-based health care (VBHC) is interprofessional collaboration in integrated practice units (IPUs) for the delivery of the complete cycle of care. High levels of interprofessional collaboration between clinical and nonclinical staff in IPUs are assumed rather than proven. Factors that may stimulate interprofessional collaboration in the context of VBHC are underresearched. PURPOSE The aim of this study was to examine relational coordination (RC) in VBHC and its antecedents. APPROACH A questionnaire was used to examine the association of both team practices and organizational conditions with interprofessional collaboration in IPUs. Gittell's Relational Coordination Survey was drawn upon to measure interprofessional collaboration by capturing the relational dynamics in coordinated working. The questionnaire also included measures of team practices (team meetings and boundary spanning behavior) and organizational conditions (task interdependence and time constraints). RESULTS The number of different professional groups participating in team meetings is positively associated with RC in IPUs. Boundary spanning behavior, task interdependence, and time constraints are not associated with RC. CONCLUSIONS In IPUs, the diversity within interprofessional team meetings is important for establishing high-quality communication and relationships. PRACTICE IMPLICATIONS Hospital managers should prioritize facilitating and encouraging shared meetings to enhance RC levels among professional groups in IPUs.
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de Belvis AG. Editorial: Value-based healthcare in oncology. Front Public Health 2023; 11:1274409. [PMID: 37780437 PMCID: PMC10534953 DOI: 10.3389/fpubh.2023.1274409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 10/03/2023] Open
Affiliation(s)
- Antonio Giulio de Belvis
- Fondazione Policlinico Universitario “A. Gemelli”, Università Cattolica del Sacro Cuore, Italian National Institute of Care and Research (IRCCS), Italian National Scientific Association of Quality on Health and Social Care (ASIQUAS) National Board, Rome, Italy
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26
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Bensink M, Volkerink J, Teklenburg G, van Bavel CCAW, Kuchenbecker WKH, Cohlen BJ, Curfs MHJM. Value-based healthcare in fertility care using relevant outcome measures for the full cycle of care leading towards shared decision-making: a retrospective cohort study. BMJ Open 2023; 13:e074587. [PMID: 37696630 PMCID: PMC10496656 DOI: 10.1136/bmjopen-2023-074587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVE To determine if the introduction of value-based healthcare (VBHC) in fertility care can help to create realistic expectations in patients resulting in increased patient value, by demonstrating the relevance of defining outcome measures that truly matter to subfertile patients. DESIGN Retrospective cohort study. SETTING Tertiary fertility centre. RESULTS Time to pregnancy (TTP) and ongoing pregnancy rate (OPR), as a proxy for the live birth rate, for the full cycle of fertility care, regardless of which and how many treatment cycles performed, were identified as the most relevant medical outcome measures. Outcome measures were incorporated into a digital dashboard by using anonymised and validated patient data from the electronic patient file. We were able to present the TTP and OPR for the population as a whole as well as stratified for age, diagnosis, gravidity and type of gamete source used thereby resulting in a virtual 'patient like me' resembling the individual patient in the consultation room. CONCLUSION We have shown that, by applying VBHC principles, relevant outcome measures can be generated and stratified for different patient characteristics, in order to develop a virtual 'patient like me'. This virtual 'patient like me' can be used in the consulting room in the form of a digital dashboard, attributing to create realistic patient expectations. This facilitates healthcare providers and patients in shared decision-making.
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Affiliation(s)
- Milou Bensink
- Fertility Center, Isala Klinieken, Zwolle, The Netherlands
| | - Joy Volkerink
- Fertility Center, Isala Klinieken, Zwolle, The Netherlands
| | | | | | | | - Ben J Cohlen
- Fertility Center, Isala Klinieken, Zwolle, The Netherlands
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Abdalla R, Pavlova M, Groot W. Prioritizing Outcome Measures for Value-Based Healthcare: Physicians' Perspectives in Saudi Arabia. Value Health Reg Issues 2023; 37:62-70. [PMID: 37327619 DOI: 10.1016/j.vhri.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/31/2023] [Accepted: 05/05/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To inform the stepwise transformation to value-based healthcare in Saudi Arabia, we assess physicians' priorities for measuring general patient outcomes. This is done as an initial step toward the implementation of disease-specific outcome sets. METHODS A cross-sectional, electronic self-administered questionnaire-based study among physicians in 6 hospitals in Saudi Arabia was conducted between March 2022 and May 2022. Purposive sampling was used to select hospitals and physicians. The questionnaire included 30 health outcomes taken from about 60 disease-specific outcome sets. These were classified into 6 domains per the Outcome Measures Hierarchy Framework of Michael Porter. The physicians were asked to prioritize outcomes in each domain by their order of importance. The Relative Importance Index (RII) and multivariate binary logistic regression were used to analyze the priorities and to relate them to physicians' characteristics. RESULTS A total of 204 physicians completed the questionnaire accounting for 40% response rate. The top priority outcomes per domain were overall survival (RII 89.4%); quality of life (RII 92.4%); time to treatment (RII 90.8%); incidence of adverse effects (RII 72.9%); need for retreatment (RII 80.5%); and incidence of hospital-acquired infections (RII 89.3%). Regression analysis revealed that physician seniority is a characteristic associated with physicians' perceptions of the importance of measuring health outcomes (highest odds ratio 2.693; 95% CI 1.501-4.833; P = .001). CONCLUSION Establishing a general set of the most important outcomes that applies to all patients, including survival and mortality, quality of life, adverse events, and complications, need to be considered in the early stages of hospitals' transformation to value-based healthcare.
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Affiliation(s)
- Rawia Abdalla
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands.
| | - Milena Pavlova
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Wim Groot
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands; Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, Limburg, The Netherlands
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Leao DLL, Pavlova M, Groot W. Risk selection reduces efficiency of value-based healthcare. Int J Health Plann Manage 2023; 38:1088-1096. [PMID: 37665086 DOI: 10.1002/hpm.3648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 09/05/2023] Open
Abstract
Value-based healthcare aims to improve efficiency and value for patients. Value-based payment models are a form of provider reimbursement to achieve this. Studies on these models have found positive results, but may be biased by unintended consequences, such as risk selection. Risk selection is a multi-dimensional phenomenon that occurs at the patient, hospital, and system level, and is a source of inefficiency and inequality in healthcare. Risk selection may occur because of selection bias in the outcomes that are evaluated and rewarded, or due to the selection of lower cost patients. Risk selection may also stem from professional reputation. The motivation to engage in risk selection may also arise from differences in the meaning of value. To mitigate these unintended consequences, several strategies can be adopted. These include making value-based payment models attractive, but not mandatory, as well as incentivising transparent reporting of best practices, using adequate risk adjustment, expanding performance metrics, and including patient-reported experience measures. Other mitigation strategies could include adopting a mixture of performance measures, using mixed methods of paying physicians, and implementing monitoring and evaluation mechanisms. However, such approaches are not flawless, and the problem may never be fully solved. This perspective serves as a warning for the constant presence of risk selection, as well as informing policy makers, politicians, and organisations implementing VBP models on ways to minimise the possibility of risk selection.
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Affiliation(s)
- Diogo L L Leao
- Department of Health Services Research, CAHPRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Milena Pavlova
- Department of Health Services Research, CAHPRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Wim Groot
- Department of Health Services Research, CAHPRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Egilman AC, Rome BN, Kesselheim AS. Gauging the Value of Top-Selling Drugs in Medicare-Reply. JAMA 2023; 330:665-666. [PMID: 37581674 DOI: 10.1001/jama.2023.10961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Affiliation(s)
- Alexander C Egilman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Program on Regulation, Therapeutics, and Law (PORTAL), Boston, Massachusetts
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Benjamin N Rome
- Division of Pharmacoepidemiology and Pharmacoeconomics, Program on Regulation, Therapeutics, and Law (PORTAL), Boston, Massachusetts
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Aaron S Kesselheim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Program on Regulation, Therapeutics, and Law (PORTAL), Boston, Massachusetts
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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30
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Leow JJ, Yong DZ, Chong YL. Value-based healthcare for bladder cancer patients undergoing robot-assisted radical cystectomy. Eur J Surg Oncol 2023; 49:1329-1330. [PMID: 37550011 DOI: 10.1016/j.ejso.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/09/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Jeffrey J Leow
- Department of Urology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Daniel Zp Yong
- Department of Urology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yew-Lam Chong
- Department of Urology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Laranjeira C. Dignity promotion in people with advanced chronic diseases: contributions for a value-based healthcare practice. Front Public Health 2023; 11:1156830. [PMID: 37575126 PMCID: PMC10415073 DOI: 10.3389/fpubh.2023.1156830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Affiliation(s)
- Carlos Laranjeira
- Department of Nursing Science, School of Health Sciences of Polytechnic of Leiria, Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal
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32
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Lin CE, Nguyen TM, McGrath R, Patterson A, Hall M. Dental Health Services Victoria value-based health care principles for oral health models of care. J Public Health Dent 2023; 83:325-328. [PMID: 37584232 DOI: 10.1111/jphd.12581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/08/2023] [Accepted: 07/17/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Efforts to progress oral healthcare reform can be challenging with competing interests of governments and service providers to achieve the intended outcomes. The value-based health care approach has been adopted in many areas of healthcare but has had limited applications to oral healthcare systems. Dental Health Services Victoria, an Australian state government funded entity, commenced its journey to value-based health care in 2016, to shift away from traditional dental service models that reward activity and volume towards a stronger emphasis on value and outcomes. AIMS To maintain the value-based health care agenda focus, Dental Health Services Victoria developed three key principles, which can be adopted by other organisations engaged in reforming oral healthcare, to improve the oral health for the population it serves. MATERIALS & METHODS In 2018, Dental Health Services Victoria developed a value-based health care framework, which has informed strategic organisation priorities for action. In 2023, the following three key principles are identified as being essential to support the operationalisation and development of effective models of oral healthcare: Principle 1 - Care is co-designed with the person or population Principle 2 - Prevention and early intervention are prioritised. Principle 3 - Consistent measurement of health outcomes and costs are embedded. DISCUSSION The exploration of the three key principles is an important communication tool to translate value-based health care into practice with key stakeholders. Further work is required to socialise them to within dental teams. CONCLUSION Organisations looking to commence the value-based health care agenda can apply Dental Health Services Victoria's three key principles as a first step.
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Affiliation(s)
- Clare Elizabeth Lin
- Dental Health Services Victoria, Carlton, Victoria, Australia
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tan Minh Nguyen
- Dental Health Services Victoria, Carlton, Victoria, Australia
- Deakin Health Economics, Deakin University, Burwood, Victoria, Australia
- Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Roisin McGrath
- Dental Health Services Victoria, Carlton, Victoria, Australia
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Amy Patterson
- Dental Health Services Victoria, Carlton, Victoria, Australia
| | - Martin Hall
- Dental Health Services Victoria, Carlton, Victoria, Australia
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Nguyen TM, Bridge G, Hall M, Theodore K, Lin C, Scully B, Heredia R, Le LKD, Mihalopoulos C, Calache H. Is value-based healthcare a strategy to achieve universal health coverage that includes oral health? An Australian case study. J Public Health Policy 2023; 44:310-324. [PMID: 37142745 PMCID: PMC10232653 DOI: 10.1057/s41271-023-00414-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/06/2023]
Abstract
The 2021 Resolution on Oral Health by the 74th World Health Assembly supports an important health policy direction: inclusion of oral health in universal health coverage. Many healthcare systems worldwide have not yet addressed oral diseases effectively. The adoption of value-based healthcare (VBHC) reorients health services towards outcomes. Evidence indicates that VBHC initiatives are improving health outcomes, client experiences of healthcare, and reducing costs to healthcare systems. No comprehensive VBHC approach has been applied to the oral health context. Dental Health Services Victoria (DHSV), an Australian state government entity, commenced a VBHC agenda in 2016 and is continuing its efforts in oral healthcare reform. This paper explores a VBHC case study showing promise for achieving universal health coverage that includes oral health. DHSV applied the VBHC due to its flexibility in scope, consideration of a health workforce with a mix of skills, and alternative funding models other than fee-for-service.
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Affiliation(s)
- Tan M Nguyen
- Deakin Health Economics, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia.
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia.
- Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Gemma Bridge
- Queen Mary University of London, Mile End Road, London, E1 4NS, UK
| | - Martin Hall
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Katy Theodore
- Deakin Health Economics, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
| | - Clare Lin
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
- Melbourne Dental School, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Ben Scully
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
| | - Ruth Heredia
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
| | - Long K-D Le
- Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Cathrine Mihalopoulos
- Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Hanny Calache
- Deakin Health Economics, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
- La Trobe University, Bendigo, VIC, 3552, Australia
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Kee C, Bozic KJ. Value-based Healthcare: Building the Right Team. Clin Orthop Relat Res 2023; 481:1078-1079. [PMID: 37145110 PMCID: PMC10194808 DOI: 10.1097/corr.0000000000002691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/12/2023] [Indexed: 05/06/2023]
Affiliation(s)
- Clarence Kee
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Kevin J. Bozic
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
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van Elten HJ, Howard SW, De Loo I, Schaepkens F. Reflections on Managing the Performance of Value-Based Healthcare: A Scoping Review. Int J Health Policy Manag 2023; 12:7366. [PMID: 37579381 PMCID: PMC10461846 DOI: 10.34172/ijhpm.2023.7366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 04/07/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Value-based healthcare (VBHC), which can be viewed as a strategy to organize and improve healthcare services, has far-reaching organizational and managerial consequences. It is common managerial practice to support the execution of a strategy by monitoring the ensuing activities. Such monitoring provides feedback and guidance on the execution of these activities to the management of an organization and helps to realize organizational strategies. Monitoring of activities is commonly done by performance management systems. Given the rising attention in the literature and in practice for VBHC, we ask to what extent VBHC is supported by performance management systems in practice, and how we can explain what we find to support further successful implementation of VBHC. METHODS In our scoping review of financial and performance management at the organization or unit-level of healthcare organizations that apply value-based approaches, we identified 1267 unique papers in Embase, Medline, OVID, and Web of Science. After the (double-blinded) title and abstract screening, 398 full-text articles were assessed for further analysis. RESULTS Our review reveals only eleven original papers discussing specifically the integration of VBHC and performance management systems. Almost all the featured applications in these papers focus on a specific project or medical specialty. Only one paper exemplifies how VBHC has been integrated with the performance management systems of a medical institution, and no paper provides a clear link with strategy execution. We ask why this is the case and propose several explanations by studying the extant performance management literature. We see these explanations as issues for further reflection for VBHC practitioners and researchers. CONCLUSION We conclude that one of the reasons for the absence of papers integrating VBHC and performance management systems is formed by the tensions that exist between striving for "the best care" or even for providing "all care that is viably possible" and pursuing greater (financial) efficiency. Implementing VBHC as an important organizational strategy and explicating this strategy in the performance management systems requires that these tensions need to be brought into the fore. When this is not done, we believe that VBHC adoptions that are fully integrated with performance management systems will remain limited in practice.
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Affiliation(s)
| | - Steven W. Howard
- Health Services Administration Department, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ivo De Loo
- Nyenrode Business Universiteit, Breukelen, The Netherlands
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Hilhorst N, Roman E, Borzée J, Deprez E, Hoorens I, Cardoen B, Roodhooft F, Lambert J. Value in psoriasis (IRIS) trial: implementing value-based healthcare in psoriasis management - a 1-year prospective clinical study to evaluate feasibility and value creation. BMJ Open 2023; 13:e067504. [PMID: 37221023 PMCID: PMC10230887 DOI: 10.1136/bmjopen-2022-067504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 05/02/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Currently, the healthcare sector is under tremendous financial pressure, and many acknowledge that a dramatic shift is required as the current system is not sustainable. Furthermore, the quality of care that is delivered varies strongly. Several solutions have been proposed of which the conceptual framework known as value-based healthcare (VBHC) is further explored in this study for psoriasis. Psoriasis is a chronic inflammatory skin disease, which is associated with a high disease burden and high treatment costs. The objective of this study is to investigate the feasibility of using the VBHC framework for the management of psoriasis. METHODS AND ANALYSIS This is a prospective clinical study in which new patients attending the psoriasis clinic (PsoPlus) of the Ghent University Hospital will be followed up during a period of 1 year. The main outcome is to determine the value created for psoriasis patients. The created value will be considered as a reflection of the evolution of the value score (ie, the weighted outputs (outcomes) divided by weighted inputs (costs)) obtained using data envelopment analysis. Secondary outcomes are related to comorbidity control, outcome evolution and treatment costs. In addition, a bundled payment scheme will be determined as well as potential improvements in the treatment process. A total of 350 patients will be included in this trial and the study initiation is foreseen on 1 March 2023. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of the Ghent University Hospital. The findings of this study will be disseminated by various means: (1) publication in one or more peer-reviewed dermatology and/or management journals, (2) (inter)national congresses, (3) via the psoriasis patient community and (4) through the research team's social media channels. TRIAL REGISTRATION NUMBER NCT05480917.
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Affiliation(s)
- Niels Hilhorst
- Dermatology Research Unit (DRU), Ghent University, Ghent, Belgium
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
| | - Erin Roman
- Health Care Management Centre, Vlerick Business School, Ghent, Belgium
- Faculty of Economics and Business, Catholic University of Leuven, Leuven, Belgium
| | - Joke Borzée
- Health Care Management Centre, Vlerick Business School, Ghent, Belgium
- Faculty of Economics and Business, Catholic University of Leuven, Leuven, Belgium
| | - Elfie Deprez
- Dermatology Research Unit (DRU), Ghent University, Ghent, Belgium
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
| | - Isabelle Hoorens
- Dermatology Research Unit (DRU), Ghent University, Ghent, Belgium
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
| | - Brecht Cardoen
- Health Care Management Centre, Vlerick Business School, Ghent, Belgium
- Faculty of Economics and Business, Catholic University of Leuven, Leuven, Belgium
| | - Filip Roodhooft
- Faculty of Economics and Business, Catholic University of Leuven, Leuven, Belgium
- Accounting and Finance, Vlerick Business School, Ghent, Belgium
| | - Jo Lambert
- Dermatology Research Unit (DRU), Ghent University, Ghent, Belgium
- Department of Dermatology, University Hospital Ghent, Ghent, Belgium
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van Engen V, Bonfrer I, Ahaus K, Buljac-Samardzic M. Identifying consensus on activities that underpin value-based healthcare in outpatient specialty consultations, among clinicians. Patient Educ Couns 2023; 109:107642. [PMID: 36696878 DOI: 10.1016/j.pec.2023.107642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To find a consensus on clinicians' and patients' activities that underpin an ideal value-based outpatient specialty consultation, among clinicians. METHODS A three-round online Delphi study was conducted. A purposive sample of nineteen clinicians from a Dutch university hospital judged activities on importance. Consensus was defined at 80% agreement. Activities were thematically analyzed to derive conceptual themes. RESULTS The expert panel agreed on 63 activities as being important for an ideal value-based outpatient specialty consultation and two activities as being unimportant. They failed to reach a consensus on 11 activities. Conceptual themes for activities that were considered important regard: 1) empowerment, 2) patient-reported biopsychosocial outcomes, 3) the patient as a person, 4) the patient's kin, 5) shared power and responsibility, 6) optimization, 7) coordination, 8) therapeutic relationships, and 9) resource-consciousness. CONCLUSION A value-based outpatient specialty consultation requires contextual decision-making, is person-centered, and focusses attention on care optimization and intelligent resource allocation. No importance is attributed to healthcare's societal burden and climate footprint. Disparities existed in various areas including the role of patient reported experience measures, "patient-like-me" data, and healthcare costs. PRACTICE IMPLICATIONS This study contributes a toolbox to guide and evaluate clinicians' and patients' behaviors in value-based outpatient specialty consultations and reveals opportunities to enhance facilitation.
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Affiliation(s)
- Veerle van Engen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3000 DR Rotterdam, the Netherlands.
| | - Igna Bonfrer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3000 DR Rotterdam, the Netherlands.
| | - Kees Ahaus
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3000 DR Rotterdam, the Netherlands.
| | - Martina Buljac-Samardzic
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3000 DR Rotterdam, the Netherlands.
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Chen M, Sepucha K, Bozic KJ, Jayakumar P. Value-based Healthcare: Integrating Shared Decision-making into Clinical Practice. Clin Orthop Relat Res 2023; 481:448-450. [PMID: 36735904 PMCID: PMC9928684 DOI: 10.1097/corr.0000000000002580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Michelle Chen
- University of California San Diego School of Medicine, La Jolla, CA, USA
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Karen Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin J. Bozic
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Prakash Jayakumar
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
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Bell L, Thom B, Chino F. Value-Based Health Care: Evaluating the Education of Future Radiation Oncologists on Costs and Affordability. J Am Coll Radiol 2023; 20:59-62. [PMID: 36496086 PMCID: PMC9898151 DOI: 10.1016/j.jacr.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/31/2022] [Accepted: 11/05/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Lauren Bell
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bridgette Thom
- Affordability Working Group and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Fumiko Chino
- Affordability Working Group and the Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
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Abstract
OBJECTIVE Although value-based healthcare (VBHC) views accurate cost information to be crucial in the pursuit of value, little is known about how the costs of care should be measured. The aim of this review is to identify how costs are currently measured in VBHC, and which cost measurement methods can facilitate VBHC or value-based decision making. DESIGN Two reviewers systematically search the PubMed/MEDLINE, Embase, EBSCOhost and Web of Science databases for publications up to 1 January 2022 and follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify relevant studies for further analysis. ELIGIBILITY CRITERIA Studies should measure the costs of an intervention, treatment or care path and label the study as 'value based'. An inductive qualitative approach was used to identify studies that adopted management accounting techniques to identify if or how cost information facilitated VBHC by aiding decision-making. RESULTS We identified 1930 studies, of which 215 measured costs in a VBHC setting. Half of these studies measured hospital costs (110, 51.2%) and the rest relied on reimbursement amounts. Sophisticated costing methods that allocate both direct and indirect costs to care paths were seen as able to provide valuable managerial information by facilitating care path adjustments (39), benchmarking (38), the identification of cost drivers (47) and the measurement of total costs or cost savings (26). We found three best practices that were key to success in cost measurement: process mapping (33), expert input (17) and observations (24). CONCLUSIONS Cost information can facilitate VBHC. Time-driven activity-based costing (TDABC) is viewed as the best method although its ability to inform decision-making depends on how it is implemented. While costing short, or partial, care paths and surgical episodes produces accurate cost information, it provides only limited decision-making information. Practitioners are advised to focus on costing full care cycles and to consider both direct and indirect costs through TDABC.
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Affiliation(s)
- Maura Leusder
- Erasmus School of Health Policy & Management, Department Health Services Management & Organization, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Petra Porte
- Erasmus School of Health Policy & Management, Department Health Services Management & Organization, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Kees Ahaus
- Erasmus School of Health Policy & Management, Department Health Services Management & Organization, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Hilco van Elten
- Erasmus School of Health Policy & Management, Department Health Services Management & Organization, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Center for Corporate Reporting, Finance & Tax, Nyenrode Business Universiteit, Breukelen, The Netherlands
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Walshe J, Akbari A, Hawthorne AB, Laing H. Data linkage can reduce the burden and increase the opportunities in the implementation of Value-Based Health Care policy: a study in patients with ulcerative colitis (PROUD-UC Study). Int J Popul Data Sci 2022; 6:1705. [PMID: 37649471 PMCID: PMC10464864 DOI: 10.23889/ijpds.v6i3.1705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Healthcare systems face rising demand and unsustainable cost pressures. In response, health policymakers are adopting Value-Based Health Care (VBHC), targeting available resources to achieve the best possible patient outcomes at the lowest possible cost and actively disinvesting in care of low-value. This requires the evaluation of longitudinal clinical and patient reported outcome measures (PROMs) at an individual-level and population-scale, which can create significant data challenges. Achieving this through routinely collected electronic health record (EHR) data-linkage could facilitate the implementation of VBHC without an unacceptable data burden on patients or health systems and release time for higher-value activities. Objectives Our study tested the ability to report an international, patient-centred outcome dataset (ICHOM-IBD) using only anonymised individual-level population-scale linked electronic health record (EHR) data sources, including clinical and patient-reported outcomes, in a cohort of patients with moderate-to-severe ulcerative colitis (UC), receiving biopharmaceutical therapies ("biologics") in a single, publicly funded, healthcare system. Results We identified a cohort of 17,632 patients with UC in Wales and a cohort from two Health Boards of 447 patients with UC receiving biologics. 112 of these patients had completed 866 condition-specific PROMs during their biologics treatment. 44 out of 59 (74.6%) items in the ICHOM-IBD could be derived from routinely collected data of which a primary care source was essential for eight items and desirable for 21. Conclusions We demonstrated that it is possible to report most but not all the ICHOM-IBD outcomes using routinely collected data from multiple sources without additional system burden, potentially supporting Value-Based Health Care implementation with population data science. As digital collection of PROMs and use of condition-specific registries grow, greater utility of this approach can be anticipated. We have identified that the availability of longitudinal primary and secondary care data linked with PROMs is essential for this to be possible.
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Affiliation(s)
- John Walshe
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Wales, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Wales, UK
| | | | - Hamish Laing
- Value-Based Health and Care Academy, Faculty of Humanities and Social Sciences, Swansea University, Wales, UK
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