National Institute of Health Technology Assessment and Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
National Institute of Health Technology Assessment, Federal University of Rio Grande do Sul, and Pontifical Catholic University of Rio Grande do Sul Polytechnic School, Porto Alegre, Brazil.
J Healthc Manag. 2021 Jun 29;66(5):340-365. doi: 10.1097/JHM-D-20-00283.
Value-based initiatives are growing in importance as strategic models of healthcare management, prompting the need for an in-depth exploration of their outcome measures. This systematic review aimed to identify measures that are being used in the application of the value agenda. Multiple electronic databases (PubMed/MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials) were searched. Eligible studies reported various implementations of value-based healthcare initiatives. A qualitative approach was used to analyze their outcome measurements. Outcomes were classified according to a tier-level hierarchy. In a radar chart, we compared literature to cases from Harvard Business Publishing. The value agenda effect reported was described in terms of its impact on each domain of the value equation. A total of 7,195 records were retrieved; 47 studies were included. Forty studies used electronic health record systems for data origin. Only 16 used patient-reported outcome surveys to cover outcome tiers that are important to patients, and 3 reported outcomes to all 6 levels of our outcome measures hierarchy. A considerable proportion of the studies (36%) reported results that contributed to value-based financial outcomes focused on cost savings. However, a gap remains in measuring outcomes that matter to patients. A more complete application of the value agenda by health organizations requires advances in technology and culture change management.
随着医疗保健管理的战略模式,基于价值的举措变得越来越重要,这促使我们需要深入探讨其结果衡量标准。本系统评价旨在确定在应用价值议程中使用的衡量标准。我们在多个电子数据库(PubMed/MEDLINE、Embase、Scopus、Cochrane 对照试验中心注册库)中进行了搜索。合格的研究报告了各种基于价值的医疗保健举措的实施情况。我们使用定性方法来分析其结果衡量标准。根据层次级别对结果进行分类。在雷达图中,我们将文献与哈佛商业出版社的案例进行了比较。报告的价值议程效应是根据其对价值等式各个领域的影响来描述的。共检索到 7195 条记录,纳入 47 项研究。其中 40 项研究使用电子健康记录系统作为数据来源。只有 16 项研究使用患者报告的结果调查来涵盖对患者重要的结果层次,有 3 项研究报告了我们结果衡量标准层次的所有 6 个层次的结果。相当一部分研究(36%)报告的结果有助于以节省成本为重点的基于价值的财务结果。然而,在衡量对患者重要的结果方面仍存在差距。医疗机构更全面地应用价值议程需要在技术和文化变革管理方面取得进展。
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