BACKGROUND: The Value-Based Health Care (VBHC) model of care provides insights into patient characteristics, outcomes, and costs of care delivery that help clinicians counsel patients. This study compares the allocation and value of curative oncological treatment in frail and fit older patients with esophageal cancer in a dedicated VBHC pathway.
METHODS: Data was collected from patients with primary esophageal cancer without distant metastases, aged 70 years or older, and treated at a Dutch tertiary care hospital between 2015 and 2019. Geriatric assessment (GA) was performed. Outcomes included treatment discontinuation, mortality, quality of life (QoL), and physical functioning over a one-year period. Direct hospital costs were estimated using activity-based costing.
RESULTS: In this study, 89 patients were included with mean age 75 years. Of 56 patients completing GA, 19 were classified as frail and 37 as fit. For frail patients, the treatment plan was chemoradiotherapy and surgery (CRT&S) in 68% (13/19) and definitive chemoradiotherapy (dCRT) in 32% (6/19); for fit patients, CRT&S in 84% (31/37) and dCRT in 16% (6/37). Frail patients discontinued chemotherapy more often than fit patients (26% (5/19) vs 11% (4/37), p = 0.03) and reported lower QoL after six months (mean 0.58 [standard deviation (SD) 0.35] vs 0.88 [0.25], p < 0.05). After one year, 11% of frail and 30% of fit patients reported no decline in physical functioning and QoL and survived. Frail and fit patients had comparable mean direct hospital costs (€24 K [SD €13 K] vs €23 K [SD €8 K], p = 0.82).
CONCLUSIONS: The value of curative oncological treatment was lower for frail than for fit patients because of slightly worse outcomes and comparable costs. The utility of the VBHC model of care depends on the availability of sufficient data. Real-world evidence in VBHC can be used to inform treatment decisions and optimization in future patients by sharing results and monitoring performance over time.
BACKGROUND: The study was retrospectively registered at the Netherlands Trial Register (NTR), trial number NL8107 (date of registration: 22-10-2019).

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BACKGROUND: While healthcare organizations in several countries are embracing Value-Based Health Care (VBHC), there are limited insights into how to achieve this paradigm shift. This study examines the decade-long (2012-2023) change towards VBHC in a pioneering Dutch university hospital.
METHODS: Through retrospective, complexity-informed process research, we study how a Dutch university hospital\'s strategy to implement VBHC evolved, how implementation outcomes unfolded, and the underlying logic behind these developments. Data include the hospital\'s internal documents (n = 10,536), implementation outcome indicators (n = 4), a survey among clinicians (n = 47), and interviews with individuals contributing to VBHC at the hospital level (n = 20).
RESULTS: The change towards VBHC is characterized by three sequential strategies. Initially, the focus was on deep change through local, tailored implementation of multiple VBHC elements. The strategy then transitioned to a hospital-wide program aimed at evolutionary change on a large scale, emphasizing the integration of VBHC into mainstream IT and policies. Recognizing the advantages and limitations of both strategies, the hospital currently adopts a \"hybrid\" strategy. This strategy delicately combines deep and broad change efforts. The strategy evolved based on accumulated insights, contextual developments and shifts in decision-makers. The complexity of change was downplayed in plans and stakeholder communication. By the end of 2023, 68 (sub)departments engaged in VBHC, enabled to discuss patients\' responses to Patient Reported Outcomes Measures (PROMs) during outpatient care. However, clinicians\' use of PROMs data showed limitations. While pioneers delved deeper into VBHC, laggards have yet to initiate it.
CONCLUSIONS: VBHC does not lend itself to linear planning and is not easily scalable. While there appears to be no golden standard for implementation, blending local and larger-scale actions appears advantageous. Local, deep yet harmonized and system-integrated changes culminate in large scale transformation. Embracing complexity and focusing on the ultimate aims of (re)institutionalization and (re)professionalization are crucial.

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.

BACKGROUND: Chronic diseases are associated with a high disease burden. Under- and overprovision of care as well as quality variation between health care providers persists, while current quality indicators rarely capture the patients\' perspective. Capturing patient-reported outcome measures (PROMs) as well as patient-reported experience measures (PREMs) is becoming more and more important to identify gaps in care provision, prioritize services most valuable to patients, and aid patients\' self-management.
OBJECTIVE: This study aims to measure the potential benefits and effectiveness of using electronic patient-reported outcome measures (ePROMs) and electronic patient-reported experience measures in a structured and population-based manner to enhance health care for chronic disease patients in Germany.
METHODS: This prospective cohort study aims to evaluate the potential benefits of PROM usage in patients with chronic diseases. We evaluate whether (1) digitally collected PROMs and PREMs can be used for health system performance assessment by generating a representative response of chronically diseased individuals with asthma, chronic obstructive pulmonary disease, diabetes, and coronary artery disease across Germany, and (2) based on the PROMs and PREMs, low-value care can be identified. As patient-reported outcomes (PROs) are rarely presented back to patients, (3) this study also examines patients\' reactions to their PROM scores in the form of digital PRO feedback. For these purposes, randomly selected patients from a nationwide German insurer are digitally surveyed with generic and disease-specific PROMs and PREMs, as well as additional questions on their health-related behavior, 4 times over 1 year. Individual PRO feedback is presented back to patients longitudinally and compared to a peer group after each survey period. Patient-reported data is linked with health insurance data. Response rates, changes in health and experience outcomes over time, self-reported changes in health behavior, and health care system usage will be analyzed.
RESULTS: The PROMchronic study explores the usage of PROMs in patients with chronic diseases. Data collection began in October 2023, after the initial invitation letter. All the 200,000 potential patients have been invited to participate in the study. Data have not yet been analyzed. Publication of the interim results is planned for the autumn of 2024, and the results are planned to be published in 2025.
CONCLUSIONS: We aim to fill the research gap on the population-based usage of PROMs and PREMs in patients with chronic diseases and add to the current understanding of PROM data-sharing with patients. The study\'s results can thereby inform whether a health care system-wide approach to collecting PROMs and PREMs can be used to identify low-value care, assess quality variation within and across chronic conditions, and determine whether PRO feedback is helpful and associated with any changes in patients\' health behaviors.
BACKGROUND: German Clinical Trials Register DRKS00031656; https://drks.de/search/en/trial/DRKS00031656.
UNASSIGNED: DERR1-10.2196/56487.

BACKGROUND: Value-based healthcare (VBHC) aims to increase patient outcomes in relation to the costs incurred, with a focus on measuring these outcomes using patient-reported outcome measures (PROMs). The German healthcare system faces the challenge of quality disparities in care amidst rising costs, making VBHC of interest.
OBJECTIVE: This paper aims to illustrate how VBHC principles are currently being implemented in the field of internal medicine in Germany and to identify the potential that can be derived from VBHC pioneering examples from the Netherlands.
METHODS: Selected case studies are presented to illustrate how VBHC principles are already being applied in internal medicine, focusing on where PROMs are utilized and how value-based reimbursement supports VBHC implementation-both in Germany and the Netherlands.
RESULTS: In Germany, various cross-provider initiatives and individual providers implement the VBHC element of PROMs measurement. In addition, the Baden-Württemberg selective contract in cardiology demonstrates how financing VBHC elements in regular care was already made possible in Germany. Pioneers such as the Dutch center of excellence Diabeter and the multidisciplinary care network Netherlands Heart Network provide further inspiration for the implementation of VBHC in internal medicine.
CONCLUSIONS: While various initiatives support the measurement of PROMs in the German context, the use of these results in care practice is not apparent. The utilization of PROMs and strategies identified in Dutch examples could be initial steps toward fostering VBHC in Germany.
UNASSIGNED: HINTERGRUND: „Value-based healthcare“ (VBHC) zielt darauf ab, den PatientInnennutzen in Relation zu den aufgewendeten Kosten zu erhöhen und stellt hierfür „patient-reported outcome measures“ (PROMs) in den Fokus. Das deutsche Gesundheitssystem steht vor der Herausforderung von Qualitätsunterschieden in der Versorgung bei gleichzeitig steigenden Kosten, weswegen VBHC-Prinzipien auf Interesse stoßen.
UNASSIGNED: Ziel dieses Beitrags ist eine Darstellung, wie VBHC-Prinzipien im Bereich der Inneren Medizin in Deutschland momentan umgesetzt werden, und welche Potenziale sich anhand von VBHC-Vorreiterbeispielen aus den Niederlanden identifizieren lassen.
METHODS: Ausgewählte Fallstudien werden präsentiert, die verdeutlichen, wie VBHC-Prinzipien bereits in der Inneren Medizin Anwendung finden. Der Fokus liegt dabei darauf, in welchen Bereichen Ergebnisparameter mittels PROMs genutzt werden und wie eine angepasste Vergütung die VBHC-Implementierung unterstützen kann – sowohl in Deutschland als auch den Niederlanden.
UNASSIGNED: In Deutschland setzen verschiedene leistungserbringerübergreifende Initiativen sowie einzelne Leistungserbringer das VBHC-Element der PROMs ein. Darüber hinaus zeigt der baden-württembergischen Selektivvertrag in der Kardiologie, wie die Finanzierung von VBHC-Elementen in der Regelversorgung in Deutschland möglich ist. Vorreiter, wie das niederländische Exzellenzzentrum Diabeter und das multidisziplinäre Versorgungsnetzwerk Netherlands Heart Network, liefern darüber hinaus Inspirationen zur Umsetzung von VBHC.
UNASSIGNED: Verschiedene Initiativen unterstützen die Messung von PROMs in der Inneren Medizin in Deutschland. Gleichzeitig ist die Nutzung der erhobenen Daten im Behandlungskontext selten zu beobachten. Die Verwendung von PROMs sowie die Orientierung an niederländischen Beispielen könnten Schritte Richtung VBHC in Deutschland begünstigen.

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Value-based healthcare payment models are an alternative insurance payment system that compensates healthcare providers based on their patients\' outcomes rather than the individual services healthcare workers provide. This shift from the current fee-for-service model that predominates our medical system has received renewed popularity and attention within organized medicine such as the American Medical Association. Advocates believe that this new payment model will address many of the unsolved issues in healthcare such as medical waste and unsustainable healthcare costs. In practice, however, this model is plagued with a myriad of unresolved issues of its own. In this commentary, we outline these issues and suggest that the intentions of those advocating for value-based payment models are either misguided or disingenuous. We then offer solutions that preserve our current fee-for-service model while making necessary changes that will benefit both physicians and patients nationwide.

OBJECTIVE: From a value-based healthcare (VBHC) perspective, does an assessment of clinical outcomes and intervention costs indicate that providing cognitive behavioural therapy (CBT) or mindfulness to women seeking fertility treatment add value compared with no such intervention?
METHODS: Proof-of-concept business case based on a VBHC perspective that considers clinical outcomes and costs. Potential effects on psychological and fertility outcomes were based on existing research. Cost outcomes were estimated with a costing model for the Dutch fertility treatment setting.
RESULTS: Thirty-two studies were identified; 13 were included. Women who received CBT had 12% lower anxiety, 40% lower depression and 6% higher fertility quality of life; difference in clinical pregnancy rates was six percentage points (CBT [30.2%]; control [24.2%]); difference in fertility discontinuation rates was 10 percentage points (CBT [5.5%]; control [15.2%]). Women who received training in mindfulness had 8% lower anxiety, 45% lower depression and 21% higher fertility quality of life; difference in mean clinical pregnancy rate was 19 percentage points (mindfulness [44.8%]; control [26.0%]). Potential total cost savings was about €1.2 million per year if CBT was provided and €11 million if mindfulness was provided. Corresponding return on investment for CBT was 30.7%, and for mindfulness 288%. Potential cost benefits are influenced by the assumed clinical pregnancy rates; such data related to mindfulness were limited to one study.
CONCLUSIONS: The provision of CBT or mindfulness to women seeking fertility treatment could add value. Higher quality primary studies are needed on the effect of mindfulness on clinical pregnancy rates.

BACKGROUND: Mental health conditions affect one in seven young people and research suggests that current mental health services are not meeting the needs of most children and youth. Learning health systems are an approach to enhancing services through rapid, routinized cycles of continuous learning and improvement. Patient-reported outcome measures provide a key data source for learning health systems. They have also been shown to improve outcomes for patients when integrated into routine clinical care. However, implementing these measures into health systems is a challenging process. This paper describes a protocol for a formative evaluation of the implementation of patient-reported measures in a newly operational child and adolescent mental health centre in Calgary, Canada. The purpose is to optimize the collection and use of patient-reported outcome measures. Our specific objectives are to assess the implementation progress, identify barriers and facilitators to implementation, and explore patient, caregivers and clinician experiences of using these measures in routine clinical care.
METHODS: This study is a mixed-methods, formative evaluation using the Consolidated Framework for Implementation Research. Participants include patients and caregivers who have used the centre\'s services, as well as leadership, clinical and support staff at the centre. Focus groups and semi-structured interviews will be conducted to assess barriers and facilitators to the implementation and sustainability of the use of patient-reported outcome measures, as well as individuals\' experiences with using these measures within clinical care. The data generated by the patient-reported measures over the first five months of the centre\'s operation will be analyzed to understand implementation progress, as well as validity of the chosen measures for the centres\' population.
CONCLUSIONS: The findings of this evaluation will help to identify and address the factors that are affecting the successful implementation of patient-reported measures at the centre. They will inform the co-design of strategies to improve implementation with key stakeholders, which include patients, clinical staff, and leadership at the centre. To our knowledge, this is the first study of the implementation of patient-reported outcome measures in child and adolescent mental health services and our findings can be used to enhance future implementation efforts in similar settings.