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Value-Based Healthcare Enhances Preoperative Care Efficiency

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The quest for enhancing patient care while managing healthcare costs has led to the adoption of value-based healthcare (VBHC) strategies. A recent study by Humanitas Research Hospital has revealed promising results in preoperative evaluations, suggesting that VBHC principles can drastically improve patient outcomes and reduce unnecessary expenditures. The study’s outcomes underscore the significant impact of restructuring healthcare processes through tailored, value-driven approaches.

Study Overview

A quality improvement, before-and-after study was conducted to assess the effectiveness of implementing VBHC strategies in preoperative evaluation clinics. The intervention involved introducing a VBHC-tailored risk matrix in 2021, with results compared to the preintervention phase in 2019. The primary outcome measured was the reduction in the number of preoperative tests and visits, while secondary outcomes included patient outcomes and healthcare costs.

Key Findings

The study included a total of 9722 patients, with 5242 patients evaluated in 2019 and 4480 in 2021. The median age of participants was 63 years, and 23% were classified as ASA 3 and 4, indicating a higher risk profile. Notably, 26.8% of cases were day surgeries. Following the implementation of VBHC, there was a significant reduction in the number of preoperative tests ordered—from 6.2 to 5.3 per patient. Additionally, specific tests such as chest X-rays, electrocardiograms, and cardiac exams saw a marked decrease.

The duration of preoperative evaluations also shortened significantly, from an average of 373 minutes in 2019 to 290 minutes in 2021. This reduction in time not only improved patient experience but also optimized resource utilization. Despite the substantial decrease in preoperative tests and time, there was no compromise in clinical outcomes, indicating that the VBHC approach maintained patient safety and care quality.

Impact on Market Access

Implementing VBHC in preoperative care demonstrates a dual benefit—enhanced patient experience and reduced costs, which are crucial for market access. By optimizing resources and minimizing unnecessary tests, healthcare providers can offer more value-driven services, making healthcare more accessible and affordable. This approach aligns with global trends towards efficiency and patient-centered care, paving the way for broader adoption of VBHC in various healthcare settings.

Inference

Key inferences from the study include:

  • Significant reduction in unnecessary preoperative tests, leading to cost savings.
  • Shortened preoperative evaluation times, enhancing patient throughput and satisfaction.
  • Maintained clinical outcomes, ensuring patient safety and care quality.
  • Increased efficiency aligning with market access goals, making healthcare more accessible.

The study underscores the feasibility and safety of employing VBHC principles in preoperative evaluations. The evidence supports the potential for broader application across different healthcare settings, offering a model for cost-effective, patient-centered care.

Original Article:

J Anesth Analg Crit Care. 2024 Jul 8;4(1):42. doi: 10.1186/s44158-024-00161-7.

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ABSTRACT

BACKGROUND: Value-based healthcare (VBHC) is an approach that focuses on delivering the highest possible value for patients while driving cost efficiency in health services. It emphasizes improving patient outcomes and experiences while optimizing the use of resources, shifting the healthcare system’s focus from the volume of services to the value delivered. Our study assessed the effectiveness of implementing a VBHC-principled, tailored preoperative evaluation in enhancing patient care and outcomes, as well as reducing healthcare costs.

METHODS: We employed a quality improvement, before-and-after approach to assessing the effects of implementing VBHC strategies on the restructuring of the preoperative evaluation clinics at Humanitas Research Hospital. The intervention introduced a VBHC-tailored risk matrix during the postintervention phase (year 2021), and the results were compared with those of the preintervention phase (2019). The primary study outcome was the difference in the number of preoperative tests and visits at baseline and after the VBHC approach. Secondary outcomes were patient outcomes and costs.

RESULTS: A total of 9722 patients were included: 5242 during 2019 (baseline) and 4,480 during 2021 (VBHC approach). The median age of the population was 63 (IQR 51-72), 23% of patients were classified as ASA 3 and 4, and 26.8% (2,955 cases) were day surgery cases. We found a considerable decrease in the number of preoperative tests ordered for each patient [6.2 (2.5) vs 5.3 (2.6) tests, p < 0.001]. The number of preoperative chest X-ray, electrocardiogram, and cardiac exams decreased significantly with VBHC. The length of the preoperative evaluation was significantly shorter with VBHC [373 (136) vs 290 (157) min, p < 0.001]. Cost analysis demonstrated a significant reduction in costs, while there was no difference in clinical outcomes.

CONCLUSIONS: We demonstrated the feasibility, safety, and cost-effectiveness of a tailored approach for preoperative evaluation. The implementation of VBHC enhanced value, as evidenced by decreased patient time in preoperative evaluation and by a reduction in unnecessary preoperative tests.

PMID:38978057 | DOI:10.1186/s44158-024-00161-7

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