Thomsen Simon Francis, Skov Lone, Kristensen Lars Erik, Hedegaard Morten Størling, Kjellberg Jakob, Jørgensen Tanja Schjødt, Brenøe Søren, Dodge Rikke
Department of Dermatology, Bispebjerg Hospital & Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Arch Public Health. 2020 Oct 12;78:95. doi: 10.1186/s13690-020-00479-y. eCollection 2020.
Psoriasis (PsO) and psoriatic arthritis (PsA) are chronic diseases that affect patients' quality of life. The purpose of the present study was to develop a pilot outcome-based, patient-centric management model for PsO and PsA.
The non-interventional IMPROVE (Incentives for healthcare management based on patient-related outcomes and value) study being conducted in Denmark consists of 5 phases: 1) collecting real-world evidence to estimate treatment patterns and disease burden to the healthcare sector and patients; 2) identifying disease aspects which matter most to patients by use of concept mapping; 3) conducting interviews with healthcare professionals and patient organization involved in a typical PsO or PsA patient journey in order to determine relevant measures to quantify patient-identified outcomes; 4) developing a value-based remuneration model based on outcomes from phases 1-3; and 5) testing the outcome-based model in pre-selected hospitals in Denmark.
Both PsO and PsA are associated with multiple co-morbidities, increased healthcare costs, and loss of earnings. Seven important 'clusters' of disease aspects were identified for both PsO and PsA, including uncertainty about disease progression and treatments, as well as inter-personal relations with healthcare providers. Hospital-based treatment was associated with high treatment costs. Although the outcome-based model could result in strategic behavior by doctors, those involved in defining the best outcome goals consider it unlikely.
The new patient-centric outcome-based management model is expected to support optimal treatment and secure best possible outcomes for patients suffering from PsO or PsA. The practical implication of the present study are that the models developed are expected to increase focus on patient-centered healthcare, and help eliminate some of the inappropriate incentives that exist in activity-based remuneration systems.
Not applicable; data collected from patient registries in Denmark.
银屑病（PsO）和银屑病关节炎（PsA）是影响患者生活质量的慢性疾病。本研究的目的是为PsO和PsA开发一种基于结果、以患者为中心的试点管理模式。
在丹麦进行的非干预性IMPROVE（基于患者相关结果和价值的医疗管理激励措施）研究包括5个阶段：1）收集真实世界证据，以估计治疗模式和疾病对医疗部门及患者的负担；2）通过概念映射确定对患者最重要的疾病方面；3）对参与典型PsO或PsA患者诊疗过程的医疗专业人员和患者组织进行访谈，以确定量化患者确定结果的相关指标；4）基于第1 - 3阶段的结果开发基于价值的薪酬模型；5）在丹麦预先选定的医院测试基于结果的模型。
PsO和PsA均与多种合并症、医疗成本增加和收入损失相关。PsO和PsA均确定了7个重要的疾病方面“集群”，包括疾病进展和治疗的不确定性以及与医疗服务提供者的人际关系。基于医院的治疗与高治疗成本相关。虽然基于结果的模型可能会导致医生的策略性行为，但参与确定最佳结果目标的人员认为这种情况不太可能发生。
新的以患者为中心、基于结果的管理模式有望支持最佳治疗，并为患有PsO或PsA的患者确保尽可能好的结果。本研究的实际意义在于，所开发的模型有望增加对以患者为中心的医疗保健的关注，并有助于消除基于活动的薪酬系统中存在的一些不当激励措施。
不适用；数据从丹麦的患者登记处收集。
