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基于价值的医疗保健作为个体和系统层面患者管理的机遇

[Value-based healthcare as an opportunity for patient management at the individual and system level].

作者信息

Steinbeck Viktoria, Fresemann Merle Louisa, Busse Reinhard

机构信息

Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Deutschland.

出版信息

Inn Med (Heidelb). 2024 Sep;65(9):890-898. doi: 10.1007/s00108-024-01767-3. Epub 2024 Aug 2.

Abstract

BACKGROUND

Value-based healthcare (VBHC) aims to increase patient outcomes in relation to the costs incurred, with a focus on measuring these outcomes using patient-reported outcome measures (PROMs). The German healthcare system faces the challenge of quality disparities in care amidst rising costs, making VBHC of interest.

OBJECTIVES

This paper aims to illustrate how VBHC principles are currently being implemented in the field of internal medicine in Germany and to identify the potential that can be derived from VBHC pioneering examples from the Netherlands.

MATERIALS AND METHODS

Selected case studies are presented to illustrate how VBHC principles are already being applied in internal medicine, focusing on where PROMs are utilized and how value-based reimbursement supports VBHC implementation-both in Germany and the Netherlands.

RESULTS

In Germany, various cross-provider initiatives and individual providers implement the VBHC element of PROMs measurement. In addition, the Baden-Württemberg selective contract in cardiology demonstrates how financing VBHC elements in regular care was already made possible in Germany. Pioneers such as the Dutch center of excellence Diabeter and the multidisciplinary care network Netherlands Heart Network provide further inspiration for the implementation of VBHC in internal medicine.

CONCLUSION

While various initiatives support the measurement of PROMs in the German context, the use of these results in care practice is not apparent. The utilization of PROMs and strategies identified in Dutch examples could be initial steps toward fostering VBHC in Germany.

摘要

背景

基于价值的医疗保健(VBHC)旨在提高与所产生成本相关的患者治疗效果,重点是使用患者报告的结局指标(PROMs)来衡量这些效果。德国医疗保健系统在成本不断上升的情况下面临着护理质量差异的挑战,这使得VBHC备受关注。

目的

本文旨在说明VBHC原则目前在德国内科领域是如何实施的,并确定可以从荷兰的VBHC先驱案例中获得的潜力。

材料与方法

介绍选定的案例研究,以说明VBHC原则在内科中是如何已经得到应用的,重点是PROMs在何处得到利用以及基于价值的报销如何支持VBHC的实施——在德国和荷兰都是如此。

结果

在德国,各种跨供应商倡议和个别供应商实施了PROMs测量这一VBHC要素。此外,巴登-符腾堡州心脏病学选择性合同展示了在德国常规护理中为VBHC要素提供资金已经成为可能。荷兰卓越糖尿病中心(Diabeter)和多学科护理网络荷兰心脏网络(Netherlands Heart Network)等先驱为内科实施VBHC提供了进一步的启示。

结论

虽然在德国背景下有各种倡议支持PROMs的测量,但这些结果在护理实践中的应用并不明显。在荷兰案例中确定的PROMs和策略的利用可能是在德国促进VBHC的初步步骤。

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