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Kawamoto, Kensaku, Caitlin A. Houlihan, E. Andrew Balas, and David F. Lobach. ‘Improving Clinical Practice Using Clinical Decision Support Systems: A Systematic Review of Trials to Identify Features Critical to Success’. Bmj 330, no. 7494 (2005): 765.
Analysis of 70 randomised controlled trials of decision support systems showed that the siginifcant features which most helped to improve clinical practice were when the suppo... more
Analysis of 70 randomised controlled trials of decision support systems showed that the siginifcant features which most helped to improve clinical practice were when the support provided: a) was part of clinician workflow, (b) was delivered at the time and place of decision making, (c) included actionable recommendations , and (d) was computer based
3,274
2025-01-13
Lim, T. O., A. Soraya, L. M. Ding, and Z. Morad. ‘Assessing Doctors’ Competence: Application of CUSUM Technique in Monitoring Doctors’ Performance’. International Journal for Quality in Health Care 14, no. 3 (2002): 251. .
Describes a technique of assessing the peformance of medical staff in various procedures using a simple type of statistical process control analysis
158
2025-01-13
Rajkomar, Alvin, Eyal Oren, Kai Chen, Andrew M. Dai, Nissan Hajaj, Michaela Hardt, Peter J. Liu, et al. ‘Scalable and Accurate Deep Learning with Electronic Health Records’. Npj Digital Medicine 1, no. 1 (8 May 2018): 1–10
A large and detailed study showing the power of artificial intelligence to accurately predict diagnosis, mortality, length of stay and readmission rates as shown by high AUC-... more
A large and detailed study showing the power of artificial intelligence to accurately predict diagnosis, mortality, length of stay and readmission rates as shown by high AUC-ROC scores including an impressive figure of 0.90 for diagnosis
2,505
2024-04-29
Pendleton RC. We Won’t Get Value-Based Health Care Until We Agree on What “Value” Means. Harvard Business Review. Published February 27, 2018.
Refers to the results of an interesting survey by the University of Utah on perceptions of the key factors that are important to patients physicians and employers in that part... more
Refers to the results of an interesting survey by the University of Utah on perceptions of the key factors that are important to patients physicians and employers in that part of the USA. The main messages seem to be a) that physicians and patients rank the importance of various dimensions of value rather differently and that b) 45% of patients ranked "Out of pocket expenses" above "My Health Improves" (32%) This is obviously a sad reflection on the state of healthcare in the USA, but it also illustrates the multi-dimensional nature of perceptions of the meaning of "value". Unfortunately the link back to the actual survey results does not seem to provide any more details
32
2024-04-09
Thaker NG, Ali TN, Porter ME, Feeley TW, Kaplan RS, Frank SJ. Communicating Value in Health Care Using Radar Charts: A Case Study of Prostate Cancer. JOP. 2016;12(9):813-820
A useful blueprint for anyone wondering how to implement value based healthcare (VBHC) for four reasons: 1) It is coauthored by clinicians and the architects of VBHC and time ... more
A useful blueprint for anyone wondering how to implement value based healthcare (VBHC) for four reasons: 1) It is coauthored by clinicians and the architects of VBHC and time driven activity based costing (TDABC) 2) It clearly explains how the difficult and complex task of developing TDABC was achieved. 3) It demonstrates the use of a simple radar plot to display costs and outcomes, 4) It uses these methodologies to compare and display the key dimensions of value for three different methods of treating prostate cancer.
61
2024-04-08
Steinmann G, van de Bovenkamp H, de Bont A, Delnoij D. Redefining value: a discourse analysis on value-based health care. BMC Health Serv Res. 2020;20(1):862.
An interesting and informative qualitative study of perceptions of the role of value based healthcare (VBHC) among health service executives and academics in Holland. Four d... more
An interesting and informative qualitative study of perceptions of the role of value based healthcare (VBHC) among health service executives and academics in Holland. Four different patterns were observed in the roles they envisaged for VBHC : 1.For patient empowerment via greater involvement in medical decision making. 2. As a means of strengthening governance via the provision of more useful information for providers/managers. 3 As part of the professional responsibility of improving healthcare delivery. 4 Via critique - ie through noting criticisms of both the principles and practices of VBHC Common ground seemed to be that shared decision-making is / would be, a key component of VBHC.
57
2024-04-07
Carroll N, Lord JC. The Growing Importance of Cost Accounting for Hospitals. J Health Care Finance. 2016;43(2):172-185.
One of the major difficulties in the implementation of value based healthcare is the lack of accounting systems that can attribute the costs related to relevant casemix and ou... more
One of the major difficulties in the implementation of value based healthcare is the lack of accounting systems that can attribute the costs related to relevant casemix and outcome categories, This paper provides a useful overview of the key issues and different methods that have been or could be used.
48
2024-04-07
Jarman PSB. Hospital standardised mortality ratios – their use and misuse. Med Leg J. 2015;83(2):72-92.
A short summary of the key messages from the book "Redefining Healthcare" (Entry no 119 ) by these authors and a plea to physicians to get actively involved in the design and ... more
A short summary of the key messages from the book "Redefining Healthcare" (Entry no 119 ) by these authors and a plea to physicians to get actively involved in the design and implementation of value based healthcare
596
2024-04-02
Pringle M, Wilson T, Grol R. Measuring "goodness" in individuals and healthcare systems. BMJ: British Medical Journal. 2002;325(7366):704.
An interesting overview of the principles of performance measurement in health care with a list of 12 attributes to be taken into account. Gives an important warning about not... more
An interesting overview of the principles of performance measurement in health care with a list of 12 attributes to be taken into account. Gives an important warning about not holding staff accountable for indicators over which they have no control: Quote: “If the person or organisation is being measured feels (or is) powerless to influence the indicator,inappropriate measurement can also lead to
de-motivation, dysfunction and crisis”
129
2024-03-08
Moriates C, Valencia V. Emerging principles for health system value improvement programmes. BMJ Qual Saf. 2019;28(6):434-437.
Worth a look if only for Table 1 which identifies 6 factors found to be important in the successful implementation of value based (hospital) health care in the USA - with exam... more
Worth a look if only for Table 1 which identifies 6 factors found to be important in the successful implementation of value based (hospital) health care in the USA - with examples
4
2024-03-08
Chatfield SC, Volpicelli FM, Adler NM, et al. Bending the cost curve: time series analysis of a value transformation programme at an academic medical centre. BMJ Qual Saf. 2019;28(6):449-458.
An interesting hospital-wide multi-faceted intervention to increase value by decreasing costs in both medical and surgical patients. The only outcome measures used were readmi... more
An interesting hospital-wide multi-faceted intervention to increase value by decreasing costs in both medical and surgical patients. The only outcome measures used were readmission rates and mortality which did not change despite reduction in average monthly costs of 7.7% equating to a saving of approx, $US59M. Also notable for using statistical process control to track chamges, and to have devleoped some creative ways of cost accounting suitable for the private sector
17
2024-03-08
Zanotto BS, Etges APB da S, Marcolino MAZ, Polanczyk CA. Value-Based Healthcare Initiatives in Practice: A Systematic Review. J Healthc Manag. 2021;66(5):340-365.
A useful meta-analysis illustrating the variety of ways in which value- based health care is being implemented - mainly in the USA; in specialist services; and largely in resp... more
A useful meta-analysis illustrating the variety of ways in which value- based health care is being implemented - mainly in the USA; in specialist services; and largely in response to new models of funding that require some dimension of value to be taken into account. Groups sources using Porters 3 Tier classification
39
2024-03-08
Lee VS, Kawamoto K, Hess R, et al. Implementation of a Value-Driven Outcomes Program to Identify High Variability in Clinical Costs and Outcomes and Association With Reduced Cost and Improved Quality. JAMA. 2016;316(10):1061-1072
An important paper from one of the leading organisations (University of Utah Health Sciences) that has been developing methods of measuring and maximizing the value of care i... more
An important paper from one of the leading organisations (University of Utah Health Sciences) that has been developing methods of measuring and maximizing the value of care in hospitals for several years. Notable for two concepts : the 'opportunity index' that identifies conditions with a combination of high and variable costs as targets for action, and the 'perfect score index' - a pre-study definition of what constitutes ideal practice against which actual events and outcomes can then be measured. This study was focused on joint replacements, sepsis and laboratory utilization and demonstrated significant savings and improved outcomes. Makes the important point of the need demonstrate to physicians the actual costs of care as opposed to charges, and in a survey shows high approval ratings of the system by them. A good starting point and model for anyone looking to implement value-based healthcare
291
2024-03-08
Glotzbach JP, Sharma V, Tonna JE, et al. Value-driven cardiac surgery: Achieving “perfect care” after coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery. 2018;156(4)
Another study from within the University of Utah Value Driven Outcomes program - this one was imited to coronary artery bypass graft procedures and included use of a pre-defi... more
Another study from within the University of Utah Value Driven Outcomes program - this one was imited to coronary artery bypass graft procedures and included use of a pre-defined "perfect care" measusrement scale to compare the costs and outcomes of this group with those in which care fells short of this ideal,(adjusted for casemix severity) The paper was presented at a meeting of surgeons and the post-presentation discussions are appended and are of interest.
16
2024-03-08
Kawamoto K, Martin CJ, Williams K, et al. Value Driven Outcomes (VDO): a pragmatic, modular, and extensible software framework for understanding and improving health care costs and outcomes. Journal of the American Medical Informatics Association. 2015;22(1):223-235
A detailed account of the systems and software developed by the University of Utah Health Sciences to support their Value Driven Outcomes program. Notable for the high levels ... more
A detailed account of the systems and software developed by the University of Utah Health Sciences to support their Value Driven Outcomes program. Notable for the high levels of support from end users - mostly physicians
109
2024-03-04
Porter, M. Teisberg, E. Redefining Health Care : Creating Value-Based Competition on Results. Harvard Business School Press; 2006.
The book by economist and organizational scientists Michael Porter and Elisabeth Teisberg whose ideas have played a large part in the recent increased interest and activities ... more
The book by economist and organizational scientists Michael Porter and Elisabeth Teisberg whose ideas have played a large part in the recent increased interest and activities in 'value-based healthcare', and more importantly in showing how this could and should be implemented. This and his subsequent publications have focused attention on the need to shift the healthcare funding model and metrics away from volume and fee for service and towards competition on the outcomes that matter to patients.
3,523
2024-03-04
Porter ME. What Is Value in Health Care? New England Journal of Medicine. 2010;363(26):2477-2481
An interesting and useful development of Porter's ideas on the implementation of value based health care, emphasizing the need to take into account patient outcomes in three t... more
An interesting and useful development of Porter's ideas on the implementation of value based health care, emphasizing the need to take into account patient outcomes in three tiers: 1: Health status achieved or retained. 2: Process of recovery 3: Sustainability of Health -all nicely illustrated in Figure 1 as "The outcome measures hierarchy"
5,802
2024-03-04
Porter ME. A strategy for health care reform—toward a value-based system. New England Journal of Medicine. 2009;361(2):109-112.
A summary of the 6 socio-political principles / requirements for the implementation of value-based - mostly relevant to the USA because of the various distortions in the fundi... more
A summary of the 6 socio-political principles / requirements for the implementation of value-based - mostly relevant to the USA because of the various distortions in the funding and insurance coverage models in that country
1,223
2024-02-11
Endless Forms Most Beautiful: Evolving Toward Higher-Value Care. NEJM Catalyst. Published online July 26 2018 Accessed Feb 11 2024
A short and instructive but seemingly, if citations are any guide, often overlooked, NEJM Catalyst article. This outlines an interesting analytical and management methodology ... more
A short and instructive but seemingly, if citations are any guide, often overlooked, NEJM Catalyst article. This outlines an interesting analytical and management methodology for implementing and measuring value based healthcare. This involves providing physicians with the outcomes and costs of CABG procedures plotted on a phase map alongside those of their peers for comparison, and accompanied by time trends. A methodology worth replicating
(The relevant figure is shown here)