Value-Based Health Care

基于价值的医疗保健
  • 文章类型: Journal Article
    肝移植是一个非常复杂的,拯救生命,治疗许多晚期肝病患者。肝移植需要多学科团队,全系统的适应和大量投资,以及昂贵的治疗。已经提出了几个指标来监测过程和结果,然而,这些缺乏对患者的关注,也没有抓住整个过程的所有方面.大多数报告的结果都没有捕捉到那些对患者重要的结果。采用基于价值的医疗保健(VBHC)的原则,可能提供一个机会来开发那些对患者重要的指标。在这篇文章中,我们根据VBHC的原则提出了关于肝移植结果测量的共识声明,由专门的专家小组在欧洲器官移植学会(ESOT)指南\'工作组的主持下开发。总体目标是提供一个框架,以促进结果测量的发展,作为将VMC范式应用于肝移植的第一步。
    Liver transplantation is a highly complex, life-saving, treatment for many patients with advanced liver disease. Liver transplantation requires multidisciplinary teams, system-wide adaptations and significant investment, as well as being an expensive treatment. Several metrics have been proposed to monitor processes and outcomes, however these lack patient focus and do not capture all aspects of the process. Most of the reported outcomes do not capture those outcomes that matter to the patients. Adopting the principles of Value-Based Health Care (VBHC), may provide an opportunity to develop those metrics that matter to patients. In this article, we present a Consensus Statement on Outcome Measures in Liver Transplantation following the principles of VBHC, developed by a dedicated panel of experts under the auspices of the European Society of Organ Transplantation (ESOT) Guidelines\' Taskforce. The overarching goal is to provide a framework to facilitate the development of outcome measures as an initial step to apply the VMC paradigm to liver transplantation.
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  • 文章类型: Journal Article
    目的:对于全膝关节置换术(TKA)后如何使用康复访视尚无共识。我们寻求为TKA后的门诊康复就诊提供专家建议。设计:德尔菲研究。方法:首先,我们制定了一系列初步访问使用建议,特定于患者的恢复状态(即,慢,典型的,或快速恢复)和手术后的时间。然后,我们邀请了49位TKA专家参加Delphi小组。在第一轮中,我们对小组成员进行了调查,了解他们与每项初步建议的协议程度。我们根据需要进行了额外的德尔菲回合,以建立共识,我们使用RAND/UCLA方法定义。我们根据小组成员的反馈和上一轮的回应更新了每一轮的调查。结果:30名小组成员同意参加,29名小组成员完成了2轮Delphi。小组就有关访问频率的建议达成共识,访问时间,以及远程康复的使用。专家小组建议,无论恢复状态如何,应在术后第一个月以每周2次的频率在手术后1周内开始门诊康复。小组根据患者术后2至3个月的恢复状况建议不同的就诊频率。小组同意,可以建议大多数TKA后的患者进行远程康复治疗,但不适用于恢复缓慢的患者。结论:我们使用Delphi程序为TKA后的门诊康复就诊提供专家建议。我们认为这些建议可以帮助患者根据自己的喜好决定如何使用就诊。J正交运动物理学,2023年;53(9):1-9。Epub:2023年7月10日。doi:10.2519/jospt.2023.11840。
    OBJECTIVE: There is no consensus for how to use rehabilitation visits after total knee arthroplasty (TKA). We sought to develop expert recommendations for outpatient rehabilitation visit usage after TKA. DESIGN: Delphi study. METHODS: First, we developed a broad list of preliminary visit usage recommendations, which were specific to patients\' recovery status (ie, slow, typical, or fast recovery) and time since surgery. We then invited 49 TKA experts to participate on a Delphi panel. During round 1, we surveyed panelists regarding their level of agreement with each preliminary recommendation. We conducted additional Delphi rounds as needed to build consensus, which we defined using the RAND/UCLA method. We updated the survey each round based on panelist feedback and responses from the previous round. RESULTS: Thirty panelists agreed to participate, and 29 panelists completed 2 Delphi rounds. The panel reached consensus on recommendations related to visit frequency, visit timing, and the use of telerehabilitation. The panel recommended that outpatient rehabilitation should begin within 1 week after surgery at a frequency of 2 times per week for the first postoperative month regardless of recovery status. The panel recommended different visit frequencies depending on the patient\'s recovery status for postoperative months 2 to 3. The panel agreed that telerehabilitation can be recommended for most patients after TKA, but not for patients recovering slowly. CONCLUSION: We used the Delphi process to develop expert recommendations for the use of outpatient rehabilitation visits after TKA. We envision these recommendations could help patients decide how to use visits based on their own preferences. J Orthop Sports Phys Ther 2023;53(9):1-9. Epub: 10 July 2023. doi:10.2519/jospt.2023.11840.
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  • 文章类型: Journal Article
    目的:在临床医生和患者活动上达成共识,以支持理想的基于价值的门诊专科咨询,在临床医生中。
    方法:进行了三轮在线Delphi研究。来自荷兰大学医院的19名临床医生的目的样本判断了活动的重要性。共识定义为80%的协议。对活动进行了主题分析,以得出概念主题。
    结果:专家小组同意63项活动对于基于理想价值的门诊专科咨询很重要,两项活动不重要。他们未能就11项活动达成共识。被认为重要的活动的概念主题:1)赋权,2)患者报告的生物心理社会结果,3)患者作为一个人,4)病人的亲属,5)共同的权力和责任,6)优化,7)协调,8)治疗关系,9)资源意识。
    结论:基于价值的门诊专科咨询需要上下文决策,以人为中心,并将注意力集中在护理优化和智能资源分配上。医疗保健的社会负担和气候足迹并不重要。在各个领域存在差异,包括患者报告经验措施的作用,“像我一样的病人”数据,和医疗费用。
    结论:本研究提供了一个工具箱来指导和评估临床医生和患者在基于价值的门诊专科会诊中的行为,并揭示了加强便利的机会。
    To find a consensus on clinicians\' and patients\' activities that underpin an ideal value-based outpatient specialty consultation, among clinicians.
    A three-round online Delphi study was conducted. A purposive sample of nineteen clinicians from a Dutch university hospital judged activities on importance. Consensus was defined at 80% agreement. Activities were thematically analyzed to derive conceptual themes.
    The expert panel agreed on 63 activities as being important for an ideal value-based outpatient specialty consultation and two activities as being unimportant. They failed to reach a consensus on 11 activities. Conceptual themes for activities that were considered important regard: 1) empowerment, 2) patient-reported biopsychosocial outcomes, 3) the patient as a person, 4) the patient\'s kin, 5) shared power and responsibility, 6) optimization, 7) coordination, 8) therapeutic relationships, and 9) resource-consciousness.
    A value-based outpatient specialty consultation requires contextual decision-making, is person-centered, and focusses attention on care optimization and intelligent resource allocation. No importance is attributed to healthcare\'s societal burden and climate footprint. Disparities existed in various areas including the role of patient reported experience measures, \"patient-like-me\" data, and healthcare costs.
    This study contributes a toolbox to guide and evaluate clinicians\' and patients\' behaviors in value-based outpatient specialty consultations and reveals opportunities to enhance facilitation.
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  • 文章类型: Journal Article
    为了描述这些原则,process,以及针对手部和腕部状况创建国际健康结果测量联盟(ICHOM)标准集的结果。
    遵循ICHOM的标准化方法,一个由手外科医师组成的国际工作组,治疗师,研究人员聚集在一起开发一种基于证据的,以病人为中心,手和腕患者的标准结果测量。进行了多项系统评价,以支持我们选择手部和腕部疾病的结果领域和工具。在2018年3月至2020年3月之间举行了14次视频会议,并使用了修改后的Delphi流程。
    在5条测量轨道上达成共识:拇指,手指,手腕,神经,和严重的手部创伤痕迹,在适用特定分配标准的常规和扩展轨道之间有区别。标准集包含结果工具的选择和用于结果测量的预定时间点。此外,当存在多个条件时,我们开发了一个使用轨道的层次结构,我们选择了风险调整,案例混合变量。
    针对手部和腕部疾病的ICHOM标准的全球实施可以促进手部和腕部疾病患者的基于价值的医疗保健。
    针对手部和腕部疾病的ICHOM标准集可以实现临床决策,质量改进,以及治疗和医疗保健专业人员之间的比较。
    To describe the principles, process, and results of creating the International Consortium for Health Outcomes Measurement (ICHOM) standard set for hand and wrist conditions.
    Following the standardized methods of ICHOM, an international working group of hand surgeons, therapists, and researchers was assembled to develop an evidence-based, patient-centered, standard set of outcome measures for patients with hand and wrist conditions. Multiple systematic reviews were performed to support our choices of outcome domains and tools for hand and wrist conditions. Fourteen video conferences were held between March 2018 and March 2020, and a modified Delphi process was used.
    A consensus was reached on 5 measurement tracks: the thumb, finger, wrist, nerve, and severe hand trauma tracks, with a distinction between regular and extended tracks for which specific allocation criteria applied. The standard set contains a selection of outcome tools and predefined time points for outcome measurement. Additionally, we developed a hierarchy for using the tracks when there are multiple conditions, and we selected risk-adjustment, case-mix variables.
    The global implementation of the ICHOM standard set for hand and wrist conditions may facilitate value-based health care for patients with hand and wrist conditions.
    The ICHOM standard set for hand and wrist conditions can enable clinical decision making, quality improvement, and comparisons between treatments and health care professionals.
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