Monday, 20 May 2019

Value-based healthcare: the patient's perspective

Gloria Gálvez



More and more organizations are adopting the new model of value-based healthcare (VBHC) where, according to the formula developed by Michael Porter:

                                                         Results that matter to the patient
                                        Value = ______________________________
                                                                           Costs

In order for the results to be measured correctly and standardized, the International Consortium for Health Outcomes Measurement (ICHOM) -a non-profit organization recently joined by Vall d'Hebron Hospital- is defining sets of indicators standardized by clinical conditions. In this line, the Vall d'Hebron Hospital, which is implementing this new model of care, has set up working groups to define the indicators that they provide value to patients for the clinical conditions of stroke and localized prostate cancer.


In a patient-centred care model (aligned with value-based healthcare), it’s important to empower patients to be the ones who report the results that matter most to them, without interfering with the clinician's interpretation, nurse or social worker. At the same time it’s necessary to sensitize the professionals about how the patient feels and to share with them the methodology that will identify the aspects that add value to the patient.

With the methodology of design thinking and using tools such as the empathy map (image that illustrates the article) and the map of the patient's experience, the Vall d'Hebron Hospital have organized groups in which clinicians, patients, family members, social workers and patient representatives participate with the intention of jointly defining the indicators for the diseases mentioned above, and three types have been differentiated:

  1. The measures of the results reported by the patient (patient reported outcome measures, PROM), relating to problems that affect their quality of life and of which the patient reports directly. In localized prostate cancer some results have to do with the loss of social relationships, erectile dysfunction or urinary incontinence.
  2. The measures of the experiences reported by the patient (patient reported experience measures, PREM), related to their experience throughout the care cycle (primary, hospital and social) and related to aspects such as receiving clear and understandable information, if there have been shared decisions or if the waiting times have been adequate.
  3. Measurements of clinical results. These results are also important from the patient's perspective, but they are recorded by the professional and are related to survival, complications or readmissions.
These co-creation groups and the analysis of the results that are important for the patient will be the starting point of conversations and shared decisions among professionals, patients and family members. This will not only improve their relationships, but also the costs of care, since, by simplifying processes and reducing fragmented attention, more efficient results will be obtained and effectiveness and efficiency will be harmonized again.

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