Hict, Ottergemsesteenweg-Zuid 808 B/354, 9000, Gent, Belgium.
HIV Reference Centre, University Hospital of Charleroi, Charleroi, Belgium.
BMC Health Serv Res. 2022 Jan 2;22(1):13. doi: 10.1186/s12913-021-07371-7.
HIV patients face considerable acute and chronic healthcare needs and battling the HIV epidemic remains of the utmost importance. By focusing on health outcomes in relation to the cost of care, value-based healthcare (VBHC) proposes a strategy to optimize quality of care and cost-efficiency. Its implementation may provide an answer to the increasing pressure to optimize spending in healthcare while improving patient outcomes. This paper describes a pragmatic value-based healthcare framework for HIV care.
A value-based HIV healthcare framework was developed during a series of roundtable discussions bringing together 16 clinical stakeholder representatives from the Belgian HIV reference centers and 2 VBHC specialists. Each round of discussions was focused on a central question translating a concept or idea to the next level of practical implementation: 1) how can VBHC principles be translated into value-based HIV care drivers; 2) how can these value-based HIV care divers be translated into value-based care objectives and activities; and 3) how can value-based HIV care objectives and activities be translated into value-based care indicators. Value drivers were linked to concrete objectives and activities using a logical framework approach. Finally, specific, measurable, and acceptable structure, process and outcomes indicators were defined to complement the framework.
Our framework identifies 4 core value areas where HIV care would benefit most from improvements: Prevention, improvement of the cascade of care, providing patient-centered HIV care and sustaining a state-of-the-art HIV disease management context. These 4 core value areas were translated into 12 actionable core value objectives. For each objective, example activities were proposed. Indicators are suggested for each level of the framework (outcome indicators for value areas and objectives, process indicators for suggested activities).
This framework approach outlines how to define a patient- and public health centered value-based HIV care paradigm. It proposes how to translate core value drivers to practical objectives and activities and suggests defining indicators that can be used to track and improve the framework's implementation in practice.
HIV 患者面临着大量的急性和慢性医疗保健需求，因此抗击 HIV 疫情仍然至关重要。通过关注与医疗成本相关的健康结果，基于价值的医疗保健（VBHC）提出了一种优化医疗质量和成本效益的策略。它的实施可能为在改善患者预后的同时优化医疗保健支出提供了一个答案。本文描述了一种实用的基于价值的 HIV 护理框架。
在一系列圆桌讨论中，汇集了来自比利时 HIV 参考中心的 16 名临床利益相关者代表和 2 名 VBHC 专家，开发了基于价值的 HIV 医疗保健框架。每一轮讨论都集中在一个核心问题上，即将一个概念或想法转化为下一个实际实施水平：1）如何将 VBHC 原则转化为基于价值的 HIV 护理驱动因素；2）如何将这些基于价值的 HIV 护理多样化转化为基于价值的护理目标和活动；3）如何将基于价值的 HIV 护理目标和活动转化为基于价值的护理指标。使用逻辑框架方法将价值驱动因素与具体目标和活动联系起来。最后，定义了具体、可衡量和可接受的结构、过程和结果指标，以补充框架。
我们的框架确定了 HIV 护理最需要改进的 4 个核心价值领域：预防、改善护理链、提供以患者为中心的 HIV 护理和维持最先进的 HIV 疾病管理环境。这 4 个核心价值领域被转化为 12 个可操作的核心价值目标。对于每个目标，都提出了示例活动。为框架的每个级别（价值领域和目标的结果指标、建议活动的过程指标）提出了指标建议。
该框架方法概述了如何定义以患者和公众健康为中心的基于价值的 HIV 护理范例。它提出了如何将核心价值驱动因素转化为实际目标和活动，并建议定义可以用于跟踪和改进框架在实践中的实施的指标。
