Tackling the frailty burden with an integrative value-based approach: results from a mixed-methods study

Abstract

Aim The purpose of this paper is to investigate the implementation of value-based care principles in the context of frailty in the perioperative process, highlighting the importance of an integrative perspective considering medical and patient-centric outcomes as well as costs. Subject and methods This mixed-methods study employs a sequential design. Qualitative observational data were used to identify needs and barriers for implementing value-based principles, and quantitative methods were subsequently used to demonstrate the value of employing such an approach using data gathered from n = 952 patients. Propensity score matching was applied to identify the frailty-associated costs of the inpatient setting for n = 381 non-frail and n = 381 (pre-)frail patients, in particular considering patient-centric outcomes. Results The qualitative analysis identified three main challenges when implementing value-based principles in the context of perioperative care and frailty, namely challenges related to the cost, patient-centric, and integrative perspectives. In addressing these shortcomings, a quantitative analysis of a propensity score-matched sample of patients undergoing surgery shows additional frailty-associated costs of 3583.01 [1654.92; 5511.04] EUR for (pre-)frail patients and the influence of individual patient-centric attributes. Effect size Cohen’s d was 0.26. Conclusion The results demonstrate that frailty should be considered from an integrative perspective, taking cost, patient-centered outcomes, and medical outcomes into account simultaneously. The results also show the value of a research design which uses qualitative data for the identification of needs and barriers, as well as quantitative data for demonstrating the usefulness of the conceived value-based approach to perioperative care delivery.

Barriers and facilitators to shared decision-making for frail and elderly patients within the perioperative setting: A scoping review protocol

“…A literature review on the relationship between frailty and delirium of 20 articles summarized a signi cant association between frailty and postoperative delirium [39]. This illustrates the complexity and risks of clinical interventions for frail patients, representing a major challenge to patient health and healthcare costs [40]. It is possible to delay and possibly reverse frailty, provided that individual preparatory measures are implemented [41].…”

Implementation of a Comprehensive and Personalised Approach for Older People with Psychosocial Frailty in Valencia (Spain): Study Protocol for a Pre–Post Controlled Trial

“…Moreover, the bidirectional relationship between loneliness and frailty, coupled with the multidimensional nature of both constructs, underscores the need for comprehensive strategies to address these issues in older adults [ 23 ]. In this sense, the implementation of value-based healthcare principles in the context of frailty lies in addressing frailty from an integrative perspective, reorganising care around patients in an effective and efficient manner supported by digital health solutions [ 24 ]. Concretely, among the key principles of value-based care are individualized care plans, shared decision-making, holistic assessments including measurable outcomes, the provision of integrated services, and early interventions.…”

Patients’ and healthcare professionals’ perceived facilitators and barriers for shared decision-making for frail and elderly patients in perioperative care: a scoping review

“…This leads to an increased treatment risk related to postoperative complications [ 11 , 12 ]. These complications concern increased mortality, prolonged length of stay, decreased quality of life after surgery [ 13 , 14 ] and postoperative delirium [ 15 ], indicating a high level of complexity in surgical procedures for frail patients [ 16 ].…”