ABSTRACT
Abstract Objectives: To measure Quality of Life (QoL) and costs of Heart Failure (HF) outpatients in Brazil as an introduction to the Value-Based Health Care (VBHC) concept. Materials and methods: Cross-sectional study, patients with HF, with ejection fraction <50%, were recruited from three hospitals in Brazil. Two QoL (36-Item Short Form Survey [SF-36] and Minnesota Living with Heart Failure Questionnaire [MLHFQ]) and two anxiety/depression questionnaires were applied. SF-36 scores were stratified by domains. Treatment costs were calculated using the Time-Driven Activity-Based Costing (TDABC) method. Results were stratified by NYHA functional class and sex. Results: From October 2018 to January 2021, 198 patients were recruited, and the median MLHFQ (49.5 [IQR 21.0, 69.0]) and SF-36 scores demonstrated poor QoL, worse at higher NYHA classes. A third of patients had moderate/severe depression and anxiety symptoms, and women had higher anxiety scores. Mean costs of outpatient follow-up were US$ 215 ± 238 for NYHA I patients, US$ 296 ± 399 for NYHA II and US$ 667 ± 1012 for NYHA III/IV. Lab/exam costs represented 30% of the costs in NYHA I, and 74% in NYHA III/IV (US $ 63.26 vs. US$ 491.05). Conclusion: Patients with HF in Brazil have poor QoL and high treatment costs; both worsen as the NYHA classification increases. It seems that HF has a greater impact on the mental health of women. Costs increase mostly related to lab/exams. Accurate and crossed information about QoL and costs is essential to drive care and reimbursement strategies based on value.
ABSTRACT
Um sistema de saúde baseado em valor deverá entregar os melhores desfechos possíveis ao paciente, desfechos que realmente importam para ele, ao menor custo possível. O conceito é relativamente fácil de entender, mas a métrica para a sua demonstração tem sido um grande desafio dos sistemas de saúde. O presente artigo demostra a criação de um Escore de Valor em Saúde (EVS) utilizando Análise de Decisão por Multicritério, o qual pode ser aplicado em qualquer sistema de saúde para avaliar profissionais, serviços de saúde e linhas de cuidado de pacientes com condições clínicas específicas.
A value-based healthcare system must deliver the best possible patient outcomes, outcomes that really matter to the patient, at the lowest possible cost. The concept is relatively easy to understand, but the metric to demonstrate it has been a major challenge for healthcare systems. This article demonstrates the creation of a Health-Based Health Care Score (EVS) using Multi-Criteria Decision Analysis which can be applied in any health system to evaluate professionals, healthcare providers and care pathways for patients with a specific disease.
Subject(s)
Health Systems , Decision Support Techniques , Value-Based Health CareABSTRACT
Resumen La mayoría de los servicios de salud han experimentado un aumento de los costos asociados a la atención de salud lo que ha llevado a adoptar medidas para optimizar la costo-efectividad de los servicios otorgados. Desde esa perspectiva surge la atención de salud basada en el valor. El concepto de "calidad en la atención de salud" se ha definido como el grado en el cual los servicios de salud aumentan la posibilidad de generar ciertos desenlaces en salud a los que se aspira. Los indicadores de calidad de clasifican en indicadores de estructura, de proceso, y de desenlace. Los indicadores de estructura se refieren a las características del sistema de salud o de la institución hospitalaria. Los indicadores de proceso se refieren a los que el proveedor de servicios de salud realiza para el proceso de atención en salud, mientras que los indicadores de desenlace se refieren a los resultados del proceso en el paciente. El objetivo de la presente revisión es proveer un marco conceptual para dar un contexto al concepto de indicadores de calidad en salud y el rol que estos juegan en cirugía oncológica de cabeza y cuello. Se debe aspirar a lograr un mayor cumplimiento de los indicadores de calidad en cirugía oncológica de cabeza y cuello, especialmente en instituciones terciarias de referencia. Aplicar indicadores de calidad en el manejo oncológico en cabeza y cuello permitiría mejorar tanto la percepción y satisfacción del usuario, como también mejorar resultados oncológicos en estos pacientes.
Abstract Most health services have experienced an increase in the costs associated with health care, which has led to the adoption of measures to optimize the cost-effectiveness of the services provided. From this perspective, the concept of value-based health care emerged. The concept of "quality in health care" has been defined as the degree to which health services increase the possibility of generating certain desired health outcomes. Quality indicators are classified into structure, process, and outcome indicators. The structure indicators refer to the characteristics of the health system or the hospital institution. Process indicators refer to those that the health service provider performs for the health care process, while outcome indicators refer to the results of the process in the patient. The objective of this review is to provide a conceptual framework to give a context to the concept of health quality indicators and the role they play in head and neck surgical oncology. The system should aspire to achieve greater compliance with quality indicators in head and neck cancer surgery, especially in referral tertiary institutions. Applying quality indicators in head and neck cancer management would improve both user perception and satisfaction, as well as improve oncological results in these patients.
Subject(s)
Humans , Male , Female , Quality of Health Care/organization & administration , Quality Indicators, Health Care/organization & administration , Head and Neck Neoplasms/surgery , Cost Efficiency Analysis , Cost-Benefit AnalysisABSTRACT
La atención en Salud Basada en el Valor es un modelo de atención re-ciente, innovador, dirigido a garantizar mejores resultados en salud para la población atendida, paralelo a un uso óptimo de los recursos. Para su implementación, dicho modelo propone una serie de principios, los cua-les son analizados dentro del presente documento. Para esto, se tiene en cuenta no sólo sus características fundamentales, sino también, su facti-bilidad, posibles barreras y oportunidades. Los principios revisados son: unidades integradas de atención, medición de resultados en salud y cos-tos, plataformas tecnológicas, modelos de pago centrados en la atención, sistemas integrados de atención y expansión geográfica. Adicionalmente, se incluyen la atención centrado en el paciente y el trabajo en equipo co-mo componentes fundamentales de este modelo también
Value-based Health Care is a recent, innovative delivering healthcare model which has emerged as a cost-effective alter-native to provide superior health outcomes for patients while decreasing inefficiencies in the system. For its successful im-plementation this model provides a set of principles which are revised in the present article, providing insights on their feasibility, challenges and opportunities. The principles revised here are: Integrated Practice Units, Health Outcomes and Cost Measurement, Value-based Payments, enabling health systems platforms, and efficient allocation of resources. Along with the-se, a person-centered approach and stakeholders' participation and engagement have been also revised as key components of the model.
A assistência médica baseada em valor é um modelo de assis-tência inovador que visa garantir melhores resultados de saúde para a população atendida e o uso ideal dos recursos. Para sua implementação, propõe-se uma série de princípios anali-sados neste documento, uma análise na qual são levadas em consideração as características fundamentais, viabilidade, pos-síveis barreiras e oportunidades que esse modelo pode gerar. Os princípios revisados são: unidades de atendimento integra-das, mensuração de resultados de saúde e custo, plataformas tecnológicas, modelos de pagamento focados na geração de valor, sistemas / redes de atendimento integrados e expansão geográfica. Além disso, o atendimento centrado no paciente e o trabalho em equipe são incluídos como componentes funda-mentais deste modelo.