García-Lorenzo Borja, Gorostiza Ania, Alayo Itxaso, Castelo Zas Susana, Cobos Baena Patricia, Gallego Camiña Inés, Izaguirre Narbaiza Begoña, Mallabiabarrena Gaizka, Ustarroz-Aguirre Iker, Rigabert Alina, Balzi William, Maltoni Roberta, Massa Ilaria, Álvarez López Isabel, Arévalo Lobera Sara, Esteban Mónica, Fernández Calleja Marta, Gómez Mediavilla Jenifer, Fernández Manuela, Del Oro Hitar Manuel, Ortega Torres María Del Carmen, Sanz Ferrandez María Consuelo, Manso Sánchez Luís, Serrano Balazote Pablo, Varela Rodríguez Carolina, Campone Mario, Le Lann Sophie, Vercauter Piet, Tournoy Kurt, Borges Marina, Oliveira Ana Sofía, Soares Marta, Fullaondo Ane
Biosistemak Institute for Health Systems Research, Torre del Bilbao Exhibition Centre, Barakaldo, Spain.
Osakidetza Basque Health Service, Ezkerraldea Enkarterri Cruces Integrated Health Organisation, Innovation and Quality Assistant Service, Barakaldo-Bizkaia, Spain.
Eur J Public Health. 2024 Feb 5;34(1):44-51. doi: 10.1093/eurpub/ckad181.
Value-based healthcare (VBHC) is a conceptual framework to improve the value of healthcare by health, care-process and economic outcomes. Benchmarking should provide useful information to identify best practices and therefore a good instrument to improve quality across healthcare organizations. This paper aims to provide a proof-of-concept of the feasibility of an international VBHC benchmarking in breast cancer, with the ultimate aim of being used to share best practices with a data-driven approach among healthcare organizations from different health systems.
In the VOICE community-a European healthcare centre cluster intending to address VBHC from theory to practice-information on patient-reported, clinical-related, care-process-related and economic-related outcomes were collected. Patient archetypes were identified using clustering techniques and an indicator set following a modified Delphi was defined. Benchmarking was performed using regression models controlling for patient archetypes and socio-demographic characteristics.
Six hundred and ninety patients from six healthcare centres were included. A set of 50 health, care-process and economic indicators was distilled for benchmarking. Statistically significant differences across sites have been found in most health outcomes, half of the care-process indicators, and all economic indicators, allowing for identifying the best and worst performers.
To the best of our knowledge, this is the first international experience providing evidence to be used with VBHC benchmarking intention. Differences in indicators across healthcare centres should be used to identify best practices and improve healthcare quality following further research. Applied methods might help to move forward with VBHC benchmarking in other medical conditions.
基于价值的医疗保健（VBHC）是一个概念框架，旨在通过健康、护理过程和经济结果来提高医疗保健的价值。基准评估应提供有用信息以识别最佳实践，因此是提高各医疗保健组织质量的良好工具。本文旨在提供乳腺癌国际VBHC基准评估可行性的概念验证，最终目标是用于在不同卫生系统的医疗保健组织之间以数据驱动的方法分享最佳实践。
在VOICE社区（一个旨在将VBHC从理论应用到实践的欧洲医疗保健中心集群）中，收集了患者报告的、临床相关的、护理过程相关的和经济相关结果的信息。使用聚类技术识别患者原型，并定义了经过改进的德尔菲法后的指标集。使用控制患者原型和社会人口特征的回归模型进行基准评估。
纳入了来自六个医疗保健中心的690名患者。提炼出一组50个健康、护理过程和经济指标用于基准评估。在大多数健康结果、一半的护理过程指标和所有经济指标方面，各站点之间发现了具有统计学意义的差异，从而能够识别表现最佳和最差的机构。
据我们所知，这是首次提供具有VBHC基准评估意图的证据的国际经验。医疗保健中心之间指标的差异应被用于识别最佳实践，并在进一步研究后提高医疗保健质量。应用的方法可能有助于推动其他医疗状况下的VBHC基准评估。
