Developing a Value Framework: Utilizing Administrative Data to Assess an Enhanced Care Initiative

Allen, Casey J.; Eska, Jarrod S; Thaker, Nikhil G.; Feeley, Thomas W.; Kaplan, Robert S.; Huey, Ryan; Tzeng, Ching Wei D.; Lee, Jeffrey E.; Frank, Steven J.; Aloia, Thomas A.; Gottumukkala, Vijaya; Katz, Matthew H.G.

doi:10.1016/j.jss.2020.12.061

Cited by 12 publications

(8 citation statements)

References 21 publications

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“…It is clearly essential to know how patients define value, otherwise the risk exists that care development will focus on what is easy to measure instead of what is most important and of greatest value to the patients. Some major factors affecting the implementation of measuring outcome and cost are (i) data infrastructure, (ii) a systematic approach for the identification of improvement potential and the selection and implementation of improvement initiatives, (iii) governance in which roles and responsibilities of physicians regarding outcome improvement are formalized, and (iv) implementation of outcomes within hospital strategy, policy documents, and the planning and control cycle (Ahmed et al, 2019;Allen et al, 2021;Amini et al, 2021;Bodar et al, 2020;Colldén & Hellström, 2018;Cossio-Gil et al, 2022;Goretti et al, 2020;Kuklinski et al, 2020;Lansdaal et al, 2022;Marotta et al, 2020;Nilsson et al, 2017;Ramos et al, 2021;Rutherford et al, 2021;Schraut et al, 2022;St John et al, 2021;Van Veghel et al, 2020;Varela-Rodríguez et al, 2021;Zipfel et al, 2019). In moving to bundled payments, many current initiatives have been successfully centered on creating bundled payments for surgical care to reduce cost.…”

Section: Resultsmentioning

confidence: 99%

Key Success in The Transformation from Volume-Based to Value-Based Healthcare: A Scoping Review

Gunawan

Nadjib

Soraya

2022

jss

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The medical cost trend had been increasing faster than the global inflation rate. Higher costs posed a significant problem for healthcare providers, payers, and eventually patients. The concept of value-based healthcare (VBHC), which emphasized the importance of measuring outcomes relative to the costs, was introduced to mitigate the impact of these medical trends. This research used a scoping review methodology to describe the factors that affect the shift from the conventional volume-based healthcare to value-based healthcare. Data of research based on article search was conducted using online Scopus and Embase databases, resulting in 800 articles describing value-based healthcare. Duplication removal excluded 76 articles, screening excluded 295 articles, eligibility assessment excluded 76 articles, and the remaining 30 articles were included. The results of study show that VBHC was proposed as a shift in healthcare management entailing six reinforcing elements, but most hospitals have implemented only one VBHC element. The most common implemented elements are “the measurement of outcome and cost” and “the reorganization to integrated practice units.” The key success for the implementation of these elements are: (1) strong data collection to measure clinical outcomes that matter to patients, (2) clear governance of this data management, and (3) strong support from the high leadership to encourage multidisciplinary teamwork. Thus, the true VBHC system can only be reached when all the six elements are achieved. However, no single study describes a success in implementing all elements of VBHC. Hospital leaders need to be cautious when interpreting VBHC as not to think that the VBHC can be reached by cherry-picking only selected elements of VBHC.

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Section: Resultsmentioning

confidence: 99%

Key Success in The Transformation from Volume-Based to Value-Based Healthcare: A Scoping Review

Gunawan

Nadjib

Soraya

2022

jss

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“…Because it has been difficult to effectively summarize value using various multidimensional measures, a theoretical framework for this purpose has been described. 9,11,21,22 While our ability to measure value within various domains is improving, an understanding of how to weigh the importance of each unique domain remains limited. Emerging statistical methodologies allow treatment comparisons using various outcome metrics, 23 which may inform complex decision making when used within the context of a value framework.…”

Section: Discussionmentioning

confidence: 99%

Defining Priorities in Value-Based Cancer Care: Insights From the Alliance for Clinical Trials in Oncology National Cooperative Group Survey

Allen,

Snyder,

Horn

et al. 2023

JCO Oncology Practice

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PURPOSE We determine how stakeholders prioritize the importance of oncologic outcomes, patient-reported outcomes (PROs), and cancer-related health care costs. METHODS A survey was distributed to the National Clinical Trials Network Alliance for Clinical Trials in Oncology cooperative group membership from May 14 to June 30, 2022. Respondents were asked to rate (5-point Likert scale) and rank (1-9) evidence-based value domains: overall survival, treatment toxicities/complications, quality of life (QOL), financial toxicity, access to care, compliance with evidence-based care, health system performance, scientific discovery and innovation, and cost to the health care system. RESULTS A total of 514 members responded, including researchers (24.7%), nurses (19.5%), medical oncologists (17.9%), administrators (9.3%), surgical and radiation oncologists (9.1%), patient advocates (3.1%), and nonphysician providers (16.4%). Participants represented various practice settings including National Cancer Institute–designated cancer centers (29.8%), university-affiliated academic cancer centers (21%), hospital-owned oncology practices (21.8%), and others (27.4%). There was agreement in how respondents prioritized value domains (W = 0.39, P < .001). Respondents ranked patient QOL (mean rank: 2.6 ± 1.9) as most important above all other metrics including survival (mean rank: 3.5 ± 0.3) and access to care (mean rank: 3.5 ± 2.1; P < .001). Members engaged in direct patient care also ranked access to care of higher importance than nonclinicians ( P = .026). Cost to the health care system (mean rank: 7.5 ± 2.1) and health system performance (mean rank: 7 ± 2) were ranked as least important ( P < .001). Inclusion of PROs into therapeutic assessment (59.3%) was the most frequently selected priority of future cooperative group initiatives. CONCLUSION Oncology community stakeholders deemed patient-centered value domains as most important and considered patient QOL the highest priority. Inclusion of PROs into clinical trials was endorsed as an important component of therapeutic assessment. These findings can be taken into consideration when creating a value framework for inclusion in cancer clinical trials.

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“…Finally, improvement in patient experience scores reported by patient-reported outcomes and patient-reported experience measures may also be evaluated, and radar charts with value measures can be used to express the gains. 8,42 Step 11: Define the ERP Implementation Process Implementing a perioperative care pathway as a quality improvement project may pose numerous operational challenges. After the planning process, to successfully implement any change some important principles should be followed: (i) get support from all stakeholders; (ii) form an implementation team with the hospital quality improvement leaders, the recovery room and ward nurse leaders, and the perioperative anesthetists and surgical teams; (iii) adopt an established quality improvement model such as one based on "plan-do-check-act" cycles across the phases of the perioperative pathway; (iv) engage surgical teams in adopting the postoperative bundle within their assistance; and (v) audit perioperative practices to examine the new protocol compliance and keep perioperative caregivers updated.…”

Section: Step 7: Literature Search Regarding the Expected Reduction Of Los And Readmission Ratesmentioning

confidence: 99%

“…7 Evidence demonstrates that due to their impact on patient clinical outcomes (health status achieved or retained; the process of recovery; and sustainability of health), ERP initiatives have contributed to decreased overall costs of care and fewer complications. 5,8 At the same time, the evaluation of the impact of these redesign projects still lacks standardized methods to assess all-important clinical and economic outcomes and the resources needed to accomplish it. The majority of the studies are restricted to traditional outcomes such as length of stay (LOS), mortality, and surgical complication rates.…”

Section: Introductionmentioning

confidence: 99%

A Standardized Framework for Evaluating Surgical Enhanced Recovery Pathways: A Recommendations Statement from the TDABC in Health-care Consortium

Etges

Stefani

Vrochides

et al. 2021

JHEOR

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Background: Innovative methodologies to redesign care delivery are being applied to increase value in health care, including the creation of enhanced recovery pathways (ERPs) for surgical patients. However, there is a lack of standardized methods to evaluate ERP implementation costs. Objectives: This Recommendations Statement aims to introduce a standardized framework to guide the economic evaluation of ERP care-design initiatives, using the Time-Driven Activity-Based Costing (TDABC) methodology. Methods: We provide recommendations on using the proposed framework to support the decision-making processes that incorporate ERPs. Since ERPs are usually composed of activities distributed throughout the patient care pathway, the framework can demonstrate how the TDABC may be a valuable method to evaluate the incremental costs of protocol implementation. Our recommendations are based on the review of available literature and expert opinions of the members of the TDABC in Healthcare Consortium. Results: The ERP framework, composed of 11 steps, was created describing how the techniques and methods can be applied to evaluate the economic impact of an ERP and guide health-care leaders to optimize the decision-making process of incorporating ERPs into health-care settings. Finally, six recommendations are introduced to demonstrate that using the suggested framework could increase value in ERP care-design initiatives by reducing variability in care delivery, educating multidisciplinary teams about value in health, and increasing transparency when managing surgical pathways. Conclusions: Our proposed standardized framework can guide decisions and support measuring improvements in value achieved by incorporating the perioperative redesign protocols.

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Developing a Value Framework: Utilizing Administrative Data to Assess an Enhanced Care Initiative

Cited by 12 publications

References 21 publications

Key Success in The Transformation from Volume-Based to Value-Based Healthcare: A Scoping Review

Key Success in The Transformation from Volume-Based to Value-Based Healthcare: A Scoping Review

Defining Priorities in Value-Based Cancer Care: Insights From the Alliance for Clinical Trials in Oncology National Cooperative Group Survey

A Standardized Framework for Evaluating Surgical Enhanced Recovery Pathways: A Recommendations Statement from the TDABC in Health-care Consortium

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