Orlandi Riccardo, Scarci Marco, Cioffi Ugo, Guttadauro Angelo, Peschi Gianluca, Cassina Enrico Mario, Filosso Pierluigi, Raveglia Federico
Department of Thoracic Surgery, San Gerardo Hospital, ASST-Monza, Monza, Italy.
Department of Thoracic Surgery, Imperial College Healthcare NHS Trust, London, UK.
J Thorac Dis. 2023 Mar 31;15(3):1046-1056. doi: 10.21037/jtd-22-1294. Epub 2023 Mar 13.
Value-Based HealthCare (VBHC), designed by Harvard University, is an evolving model of healthcare delivery that achieves better patient outcomes and greater financial sustainability for the healthcare professionals. According to this innovative approach, the value is determined by a panel of indicators and the ratio between results and costs. Our goal was to develop a panel of thoracic-fashioned key-performance indicators (KPIs) creating a model that could be applied in thoracic surgery for the first time, reporting our early experience.
Fifty-five indicators were developed based on literature review: 37 for outcomes and 18 for costs. Outcomes were measured by a 7 level Likert scale, while overall costs were defined through the sum of the individual economic performance on each resource indicator. An observational retrospective cross-sectional study was designed to make a cost-effective evaluation of the indicators. Therefore, the Patient Value in Thoracic Surgery (PVTS) score calculated value gained for every lung cancer patient undergoing lung resection at our surgical department.
A total of 552 patients were enrolled. From 2017 to 2019 mean outcome indicators per patient were 109, 113 and 110 while mean costs per patient were 7.370, 7.536 and 7.313 euros respectively. Hospital stay and waiting time from consultation to surgery for lung cancer patients decreased from 7.3 to 5 and from 25.2 to 21.9 days, respectively. On the contrary, number of patients increased but overall costs decreased, despite cost of consumables has gone from 2.314 to 3.438 euros, since cost of hospitalization and occupancy of the operating room (OR) improved (from 4.288 to 3.158 euros). Variables analyzed showed that overall value delivered grew from 14.8 to 15.
Introducing a new concept of value, the VBHC theory applied to thoracic surgery may revolutionize traditional organizational management in lung cancer patients, showing how value delivered can increase in accordance with outcomes, despite the growth of part of the costs. Our panel of indicators has been created to provide an innovative score to successfully identify improvements needed and quantify their effectiveness in Thoracic Surgery and our early experience reports encouraging results.
由哈佛大学设计的基于价值的医疗保健（VBHC）是一种不断发展的医疗服务模式，可为医疗专业人员实现更好的患者治疗效果和更高的财务可持续性。根据这种创新方法，价值由一组指标以及结果与成本之间的比率决定。我们的目标是开发一组胸科式关键绩效指标（KPI），创建一个首次可应用于胸外科手术的模型，并报告我们的早期经验。
基于文献综述制定了55项指标：37项用于结果，18项用于成本。结果通过7级李克特量表进行衡量，而总成本则通过每个资源指标上的个体经济绩效总和来定义。设计了一项观察性回顾性横断面研究，以对这些指标进行成本效益评估。因此，胸外科手术患者价值（PVTS）评分计算了在我们外科接受肺切除的每位肺癌患者所获得的价值。
共纳入552例患者。2017年至2019年，每位患者的平均结果指标分别为109、113和110，而每位患者的平均成本分别为7370欧元、7536欧元和7313欧元。肺癌患者的住院时间和从会诊到手术的等待时间分别从7.3天降至5天和从25.2天降至21.9天。相反，患者数量增加但总成本下降，尽管耗材成本从2314欧元增至3438欧元，因为住院成本和手术室（OR）占用成本有所改善（从4288欧元降至3158欧元）。分析的变量显示，提供的总体价值从14.8增至15。
引入新的价值概念，应用于胸外科手术的VBHC理论可能会彻底改变肺癌患者的传统组织管理，表明尽管部分成本有所增加，但所提供的价值如何能随着结果的改善而增加。我们创建的指标组旨在提供一个创新评分，以成功识别所需的改进并量化其在胸外科手术中的有效性，我们的早期经验报告了令人鼓舞的结果。
