基于价值的医疗保健中价值观念的认知解析——一项访谈研究。

Untangling the perception of value in value-based healthcare - an interview study.

机构信息

Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden and Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.

Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden and Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.

出版信息

Leadersh Health Serv (Bradf Engl). 2024 Apr 16;37(5):130-141. doi: 10.1108/LHS-07-2023-0051.

DOI:10.1108/LHS-07-2023-0051

PMID:38635293

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11348837/

Abstract

PURPOSE

Value-based health care (VBHC) argues that health-care needs to re-focus to maximise value creation, defining value as the quota when dividing the outcomes important for the patient, by the cost for health care to deliver such outcomes. This study aims to explore the perception of value among different stakeholders involved in the process of implementing VBHC at a Swedish hospital to support leaders to be more efficient and effective when developing health care.

DESIGN/METHODOLOGY/APPROACH: Participants comprised 19 clinicians and non-clinicians involved in the implementation of VBHC. Semi-structured interviews were conducted and content analysis was performed.

FINDINGS

The clinicians described value as a dynamic concept, dependent on the patient and the clinical setting, stating that improving outcomes was more important than containing costs. The value for non-clinicians appeared more driven by the interplay between the outcome and the cost. Non-clinicians related VBHC to a strategic framework for governance or for monitoring different continuous improvement processes, while clinicians appreciated VBHC, as they perceived its introduction as an opportunity to focus more on outcomes for patients and less on cost containment.

ORIGINALITY/VALUE: There is variation in how clinicians and non-clinicians perceive the key concept of value when implementing VBHC. Clinicians focus on increasing treatment efficacy and improving medical outcomes but have a limited focus on cost and what patients consider most valuable. If the concept of value is defined primarily by clinicians' own assumptions, there is a clear risk that the foundational premise of VBHC, to understand what outcomes patients value in their specific situation in relation to the cost to produce such outcome, will fail. Health-care leaders need to ensure that patients and the non-clinicians' perception of value, is integrated with the clinical perception, if VBHC is to deliver on its promise.

摘要

目的

基于价值的医疗保健（VBHC）认为，医疗保健需要重新关注以最大化价值创造，将价值定义为将对患者重要的结果除以提供这些结果的医疗保健成本的比率。本研究旨在探索在瑞典一家医院实施 VBHC 过程中不同利益相关者对价值的看法，以支持领导者在制定医疗保健时更加高效和有效。

设计/方法/方法：参与者包括 19 名参与 VBHC 实施的临床医生和非临床医生。进行了半结构化访谈，并进行了内容分析。

结果

临床医生将价值描述为一个动态的概念，取决于患者和临床环境，他们表示改善结果比控制成本更重要。对于非临床医生来说，价值似乎更多地受到结果和成本之间相互作用的驱动。非临床医生将 VBHC 与治理的战略框架或监测不同的持续改进过程联系起来，而临床医生则欣赏 VBHC，因为他们认为引入 VBHC 是一个关注患者结果而不是成本控制的机会。

原创性/价值：当实施 VBHC 时，临床医生和非临床医生对关键价值概念的看法存在差异。临床医生专注于提高治疗效果和改善医疗结果，但对成本和患者认为最有价值的方面关注有限。如果价值的概念主要由临床医生自己的假设来定义，那么 VBHC 的基本前提，即了解患者在其特定情况下对结果的重视程度以及产生这种结果的成本，就有失败的风险。医疗保健领导者需要确保将患者和非临床医生对价值的看法与临床医生的看法相结合，如果 VBHC 要实现其承诺的话。