PDF(Pubmed)
Abstract：
BACKGROUND: Value-based healthcare (VBHC) is an approach that focuses on delivering the highest possible value for patients while driving cost efficiency in health services. It emphasizes improving patient outcomes and experiences while optimizing the use of resources, shifting the healthcare system\'s focus from the volume of services to the value delivered. Our study assessed the effectiveness of implementing a VBHC-principled, tailored preoperative evaluation in enhancing patient care and outcomes, as well as reducing healthcare costs.
METHODS: We employed a quality improvement, before-and-after approach to assessing the effects of implementing VBHC strategies on the restructuring of the preoperative evaluation clinics at Humanitas Research Hospital. The intervention introduced a VBHC-tailored risk matrix during the postintervention phase (year 2021), and the results were compared with those of the preintervention phase (2019). The primary study outcome was the difference in the number of preoperative tests and visits at baseline and after the VBHC approach. Secondary outcomes were patient outcomes and costs.
RESULTS: A total of 9722 patients were included: 5242 during 2019 (baseline) and 4,480 during 2021 (VBHC approach). The median age of the population was 63 (IQR 51-72), 23% of patients were classified as ASA 3 and 4, and 26.8% (2,955 cases) were day surgery cases. We found a considerable decrease in the number of preoperative tests ordered for each patient [6.2 (2.5) vs 5.3 (2.6) tests, p < 0.001]. The number of preoperative chest X-ray, electrocardiogram, and cardiac exams decreased significantly with VBHC. The length of the preoperative evaluation was significantly shorter with VBHC [373 (136) vs 290 (157) min, p < 0.001]. Cost analysis demonstrated a significant reduction in costs, while there was no difference in clinical outcomes.
CONCLUSIONS: We demonstrated the feasibility, safety, and cost-effectiveness of a tailored approach for preoperative evaluation. The implementation of VBHC enhanced value, as evidenced by decreased patient time in preoperative evaluation and by a reduction in unnecessary preoperative tests.
METHODS: We employed a quality improvement, before-and-after approach to assessing the effects of implementing VBHC strategies on the restructuring of the preoperative evaluation clinics at Humanitas Research Hospital. The intervention introduced a VBHC-tailored risk matrix during the postintervention phase (year 2021), and the results were compared with those of the preintervention phase (2019). The primary study outcome was the difference in the number of preoperative tests and visits at baseline and after the VBHC approach. Secondary outcomes were patient outcomes and costs.
RESULTS: A total of 9722 patients were included: 5242 during 2019 (baseline) and 4,480 during 2021 (VBHC approach). The median age of the population was 63 (IQR 51-72), 23% of patients were classified as ASA 3 and 4, and 26.8% (2,955 cases) were day surgery cases. We found a considerable decrease in the number of preoperative tests ordered for each patient [6.2 (2.5) vs 5.3 (2.6) tests, p < 0.001]. The number of preoperative chest X-ray, electrocardiogram, and cardiac exams decreased significantly with VBHC. The length of the preoperative evaluation was significantly shorter with VBHC [373 (136) vs 290 (157) min, p < 0.001]. Cost analysis demonstrated a significant reduction in costs, while there was no difference in clinical outcomes.
CONCLUSIONS: We demonstrated the feasibility, safety, and cost-effectiveness of a tailored approach for preoperative evaluation. The implementation of VBHC enhanced value, as evidenced by decreased patient time in preoperative evaluation and by a reduction in unnecessary preoperative tests.
摘要：
背景：基于价值的医疗保健（VBHC）是一种专注于为患者提供尽可能高的价值，同时提高医疗服务的成本效率的方法。它强调改善患者的治疗效果和体验，同时优化资源的使用，将医疗保健系统的重点从服务量转移到交付的价值。我们的研究评估了实施VBHC原则的有效性，量身定制的术前评估，以增强患者护理和预后，以及降低医疗成本。
方法：我们采用了质量改进，评估实施VBHC策略对Humanitas研究医院术前评估诊所重组的影响的前后方法。干预措施在干预后阶段(2021年)引入了VBHC量身定制的风险矩阵，并将结果与干预前阶段(2019年)的结果进行了比较。主要研究结果是基线和VBHC方法后的术前测试和访视次数的差异。次要结果是患者结果和费用。
结果：共纳入9722例患者：2019年（基线）5242例，2021年（VBHC方法）4,480例。人口的平均年龄为63岁（IQR51-72），23％的患者被分类为ASA3和4，26.8％（2,955例）为日间手术病例。我们发现每位患者的术前检查数量大大减少[6.2（2.5）vs5.3（2.6），p<0.001]。术前胸部X光片的数量，心电图,心脏检查与VBHC显著下降。VBHC[373（136）vs290（157）min，术前评估的时间明显缩短，p<0.001]。成本分析表明成本显著降低，而临床结局无差异。
结论：我们证明了可行性，安全,以及量身定制的术前评估方法的成本效益。VBHC的实现增强了价值，患者术前评估的时间减少和不必要的术前检查的减少证明了这一点。
方法：我们采用了质量改进，评估实施VBHC策略对Humanitas研究医院术前评估诊所重组的影响的前后方法。干预措施在干预后阶段(2021年)引入了VBHC量身定制的风险矩阵，并将结果与干预前阶段(2019年)的结果进行了比较。主要研究结果是基线和VBHC方法后的术前测试和访视次数的差异。次要结果是患者结果和费用。
结果：共纳入9722例患者：2019年（基线）5242例，2021年（VBHC方法）4,480例。人口的平均年龄为63岁（IQR51-72），23％的患者被分类为ASA3和4，26.8％（2,955例）为日间手术病例。我们发现每位患者的术前检查数量大大减少[6.2（2.5）vs5.3（2.6），p<0.001]。术前胸部X光片的数量，心电图,心脏检查与VBHC显著下降。VBHC[373（136）vs290（157）min，术前评估的时间明显缩短，p<0.001]。成本分析表明成本显著降低，而临床结局无差异。
结论：我们证明了可行性，安全,以及量身定制的术前评估方法的成本效益。VBHC的实现增强了价值，患者术前评估的时间减少和不必要的术前检查的减少证明了这一点。
