Gabriel Lucinda, Casey Joseph, Gee Matt, Palmer Claire, Sinha Joydeep, Moxham John, Colegate-Stone Toby James
King's Health Partners, London, UK.
Department of Orthopaedic Surgery, King's College Hospital NHS Foundation Trust, London, UK.
BMJ Open Qual. 2019 Jun 9;8(2):e000549. doi: 10.1136/bmjoq-2018-000549. eCollection 2019.
A quarter of the population present at least once a year with a musculoskeletal disorder. Primary hip osteoarthritis is a high-volume condition with significant clinical need and population-level costs. There remains much variation in patient outcomes and care delivery costs for this condition.
The study aimed to gauge if pathway redesign based on the principles of value-based healthcare (VBHC) could increase value. The aim was to calculate the value of treatment for primary hip osteoarthritis through measuring outcomes that matter to patients, as well as the costs of delivering them. Additionally it aimed to compare two care pathways to identify which elements may better promote the delivery of high-value clinical care.
Two care models were evaluated: the first being a traditional model with multiple entry points and without pathway standardisation, and the second an intentionally designed standardised multidisciplinary pathway. Mandated National Health Service patient-reported outcomes were assessed but were restructured into a patient-centred format to assess the impact on pain, function and psychological outcomes. Patient-level pathway economic evaluation was performed. Using these data, outcomes were mapped against cost to calculate value.
There were no significant differences in clinical outcomes between the two models. The intentionally designed model delivered better value care, having lower pathway costs. This model produced a small but inconsistent positive financial margin.
Intentionally designed, integrated elective services offer an opportunity to develop and evaluate VBHC models. Analysis of two care pathways from a VBHC perspective demonstrated that an intentionally designed pathway had higher value. The higher value pathway maximised the benefits of having physiotherapists and orthopaedic surgeons working side by side. Developing and measuring patient-orientated outcomes and performing accurate economic evaluation are the key to understanding and achieving better value care.
四分之一的人口每年至少出现一次肌肉骨骼疾病。原发性髋骨关节炎是一种常见疾病，有重大临床需求且涉及大量人群的医疗成本。对于这种疾病，患者的治疗结果和护理成本仍存在很大差异。
本研究旨在评估基于价值医疗保健（VBHC）原则重新设计的治疗路径是否能提高价值。目的是通过衡量对患者重要的结果以及提供这些结果的成本，来计算原发性髋骨关节炎治疗的价值。此外，旨在比较两种护理路径，以确定哪些要素可能更有助于提供高价值的临床护理。
评估了两种护理模式：第一种是具有多个切入点且无路径标准化的传统模式，第二种是特意设计的标准化多学科路径。评估了英国国家医疗服务体系规定的患者报告结果，但将其重新构建为以患者为中心的形式，以评估对疼痛、功能和心理结果的影响。进行了患者层面的路径经济评估。利用这些数据，将结果与成本进行对比以计算价值。
两种模式的临床结果无显著差异。特意设计的模式提供了价值更高的护理，路径成本更低。该模式产生了虽小但不稳定的正财务利润。
特意设计的综合择期服务为开发和评估VBHC模式提供了机会。从VBHC角度对两种护理路径进行分析表明，特意设计的路径价值更高。价值更高的路径使物理治疗师和骨科医生并肩工作的益处最大化。开发和衡量以患者为导向的结果并进行准确的经济评估是理解和实现更高价值护理的关键。
