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Abstract：
BACKGROUND: Value-based healthcare (VBHC) focusses on increasing value for patients. Hospitals aim to implement VBHC via value improvement (VI) teams for medical conditions. To determine the patient\'s perspective on value, collective patient participation is important in these teams. We therefore evaluated the current state of patient participation in VI teams and share lessons learned.
METHODS: This mixed-methods study was conducted at seven collaborating hospitals in the Netherlands. A questionnaire (the public and patient engagement evaluation tool) was tailored to the study\'s context, completed by VI team members (n = 147 from 76 different VI teams) and analysed with descriptive statistics. In addition, 30 semistructured interviews were held with VI team members and analysed through thematic analysis. Data were collected between February 2022 and January 2023 and were triangulated by mapping the quantitative results to the interview themes.
RESULTS: Thirty-eight of the 76 included VI teams reported using a form of patient participation. Many respondents (71%) indicated a lack of a clear strategy and goal for patient participation. Multiple VI team members believed that specific knowledge and skills are required for patients to participate in a VI team, but this led to concerns regarding the representativeness of participating patients. Furthermore, while patients indicated that they experienced some level of hierarchy, they also stated that they did not feel restricted hereby. Lastly, patients were satisfied with their participation and felt like equal VI team members (100%), but they did mention a lack of feedback from the VI team on their input.
CONCLUSIONS: The results imply the lack of full implementation of patient participation within VI teams. Guidelines should be developed that provide information on how to include a representative group of patients, which methods to use, how to evaluate the impact of patient participation, and how to give feedback to participating patients.
UNASSIGNED: Two patient advisors were part of the research team and attended the research team meetings. They were involved as research partners in all phases of the study, including drafting the protocol (e.g., drafting interview guides and selecting the measurement instrument), interpreting the results and writing this article.
METHODS: This mixed-methods study was conducted at seven collaborating hospitals in the Netherlands. A questionnaire (the public and patient engagement evaluation tool) was tailored to the study\'s context, completed by VI team members (n = 147 from 76 different VI teams) and analysed with descriptive statistics. In addition, 30 semistructured interviews were held with VI team members and analysed through thematic analysis. Data were collected between February 2022 and January 2023 and were triangulated by mapping the quantitative results to the interview themes.
RESULTS: Thirty-eight of the 76 included VI teams reported using a form of patient participation. Many respondents (71%) indicated a lack of a clear strategy and goal for patient participation. Multiple VI team members believed that specific knowledge and skills are required for patients to participate in a VI team, but this led to concerns regarding the representativeness of participating patients. Furthermore, while patients indicated that they experienced some level of hierarchy, they also stated that they did not feel restricted hereby. Lastly, patients were satisfied with their participation and felt like equal VI team members (100%), but they did mention a lack of feedback from the VI team on their input.
CONCLUSIONS: The results imply the lack of full implementation of patient participation within VI teams. Guidelines should be developed that provide information on how to include a representative group of patients, which methods to use, how to evaluate the impact of patient participation, and how to give feedback to participating patients.
UNASSIGNED: Two patient advisors were part of the research team and attended the research team meetings. They were involved as research partners in all phases of the study, including drafting the protocol (e.g., drafting interview guides and selecting the measurement instrument), interpreting the results and writing this article.
摘要：
背景：基于价值的医疗保健（VBHC）专注于增加患者的价值。医院旨在通过医疗条件的价值改善（VI）团队实施VBHC。为了确定患者对价值的看法，在这些团队中,患者的集体参与非常重要.因此，我们评估了患者参与VI团队的现状，并分享了经验教训。
方法：这项混合方法研究在荷兰的7家合作医院进行。调查问卷(公众和患者参与评估工具)是根据研究背景量身定做的，由VI团队成员完成（来自76个不同VI团队的n=147），并使用描述性统计数据进行分析。此外,与VI团队成员进行了30次半结构化访谈，并通过主题分析进行了分析。数据是在2022年2月至2023年1月之间收集的，并通过将定量结果映射到访谈主题来进行三角测量。
结果：76个包括VI组的38个使用患者参与的形式报告。许多受访者（71％）表示缺乏明确的患者参与策略和目标。多名VI团队成员认为，患者参加VI团队需要特定的知识和技能。但这引起了对参与患者代表性的担忧。此外，虽然患者表示他们经历了某种程度的等级制度，他们还表示，他们对此并不感到受限制。最后,患者对他们的参与感到满意，感觉像平等的VI团队成员(100%)，但是他们确实提到了VI团队对他们的投入缺乏反馈。
结论：结果暗示在VI团队中没有充分实施患者参与。应制定指南，提供有关如何包括一组具有代表性的患者的信息，使用哪些方法，如何评估患者参与的影响，以及如何向参与的患者提供反馈。
■两名患者顾问是研究小组的成员，并参加了研究小组会议。他们作为研究伙伴参与研究的所有阶段，包括起草议定书(例如，起草采访指南和选择测量仪器)，解释结果并撰写本文。
方法：这项混合方法研究在荷兰的7家合作医院进行。调查问卷(公众和患者参与评估工具)是根据研究背景量身定做的，由VI团队成员完成（来自76个不同VI团队的n=147），并使用描述性统计数据进行分析。此外,与VI团队成员进行了30次半结构化访谈，并通过主题分析进行了分析。数据是在2022年2月至2023年1月之间收集的，并通过将定量结果映射到访谈主题来进行三角测量。
结果：76个包括VI组的38个使用患者参与的形式报告。许多受访者（71％）表示缺乏明确的患者参与策略和目标。多名VI团队成员认为，患者参加VI团队需要特定的知识和技能。但这引起了对参与患者代表性的担忧。此外，虽然患者表示他们经历了某种程度的等级制度，他们还表示，他们对此并不感到受限制。最后,患者对他们的参与感到满意，感觉像平等的VI团队成员(100%)，但是他们确实提到了VI团队对他们的投入缺乏反馈。
结论：结果暗示在VI团队中没有充分实施患者参与。应制定指南，提供有关如何包括一组具有代表性的患者的信息，使用哪些方法，如何评估患者参与的影响，以及如何向参与的患者提供反馈。
■两名患者顾问是研究小组的成员，并参加了研究小组会议。他们作为研究伙伴参与研究的所有阶段，包括起草议定书(例如，起草采访指南和选择测量仪器)，解释结果并撰写本文。
