Developing process measures in value-based healthcare: the case of aortic valve disease

[摘要] Background As process measures can be means tochange practices, this article presents process measuresthat impact on outcome measures for surgical aorticvalve replacement (SAVR) and transcatheter aortic valvereplacement (TAVR) within value-based healthcare.Methods Desk research and observations of patienttrajectories were performed to map the processesinvolved in TAVR and SAVR. Semistructured interviewswere conducted with healthcare professionals (n=8)and patients (n=2) to explore which processes weremost important in relation to a standard set of outcomemeasures that was already monitored. Additionally, openinterviews (n=2) were held to prioritise results. A focusgroup was performed for validation of the formulatedprocess measures. Numerical data for these measureswas not collected.Results Process maps of the full cycle of care ofTAVR and SAVR treatments in theory and in practicewere developed. 28 processes were found importantby interview participants due to their expected impacton patient-relevant outcomes. Seven processes wereprioritised to be most important and were formulated into12 process measures for both TAVR and SAVR: ‘Numberof times that deficient information provision to SAVRpatients causes negative outcomes’, ‘Type of TAVR/SAVRprosthesis’, ‘Brand of TAVR prosthesis’, ‘Number of timesthe frailty score of a TAVR/SAVR patient >75 years ismeasured’, ‘Time between TAVR/SAVR surgery indicationand surgery’, ‘Number of times that anticoagulants arestopped within 3 days before surgery’, ‘Time in hoursbetween TAVR/SAVR surgery and permanent pacemakerimplantation’ and ‘Percentage of standardised painmeasurements’.Conclusion This study proposes an addition of selectprocess measures to standard sets of outcome measuresto improve healthcare quality. It illustrates a clear methodfor identifying process measures with impact on healthoutcomes in the future.

[学科分类] 药学