2023-2024, Block 4 GW4014MV. Value Based Services
VBS Literature summaries
Inhoud
WEEK 1: Conceptualizing VBHC........................................................................................................................3
I. Steinmann, et al. (2021). Expert consensus on moving towards a VBHC system in the NL........................3
II. VIDEO: Inleiding Waarde gedreven Zorg...................................................................................................6
Waarde voor de patiënt............................................................................................................................6
Organisatie van de zorg.............................................................................................................................6
Kosten.......................................................................................................................................................7
Sturen op kwaliteit....................................................................................................................................7
WEEK 2: Decision analysis & Decision-making..................................................................................................8
WG Video 1: Behavioural Economics – Heuristics.........................................................................................8
WG Video 2: Behavioural Economics – Bounded Rationality........................................................................9
I. Kleinmuntz & Kleinmuntz (1999). A strategic approach to allocating capital in healthcare organizations.
.................................................................................................................................................................... 10
Traditional approaches to Capital Budgeting..........................................................................................10
Decision Analysis.....................................................................................................................................10
II. Keeney (1982). Decision Analysis: An Overview......................................................................................13
The key components...............................................................................................................................13
WEEK 3: Shared Decision-making...................................................................................................................14
WG Preparation: Manual Metro Mapping..................................................................................................14
1) Getting started with Metro Mapping..................................................................................................14
2) The Metro Net & Metro Map..............................................................................................................21
3) Mapping in MS Visio...........................................................................................................................31
I. Stiggelbout et al (2015). Shared decision making: Concepts, evidence, and practice..............................32
Two lines of thinking that support the plea for SDM..............................................................................32
Concepts & Definitions...........................................................................................................................33
SDM steps...............................................................................................................................................33
II. Joseph-Williams et al (2014). Knowledge is not power for patients: a systematic review and thematic
synthesis of patient-reported barriers and facilitators to SDM...................................................................36
Figure 2...................................................................................................................................................36
III. Griffioen et al (2021). The bigger picture of SDM: a service design perspective using the care path of
locally advanced pancreatic cancer as a case..............................................................................................38
4 themes influencing SDM......................................................................................................................39
WEEK 4: Outcomes, PROMS, PREMS..............................................................................................................40
I. Cossio-Gil, et al. (2022). The Roadmap for Implementing VBHC in European University Hospitals.........40
VBHC – background................................................................................................................................40
1
,2023-2024, Block 4 GW4014MV. Value Based Services
8 mandatory components for VBHC implementation.............................................................................41
6 development phases (in the implementation process)........................................................................42
II. Hazelzet, et al. (2021). VBHC’s blind spots: call for a dialogue................................................................45
Values (convictions that guide decisions)................................................................................................45
Value (in an economic sense)..................................................................................................................45
Separating the ideas...............................................................................................................................46
III. Aiyegbusi, et al. (2022). Key considerations to reduce or address respondent burden in patient-
reported outcome (PRO) data collection....................................................................................................47
Issues pertaining to respondent burden in PRO collection for clinical trials and routine practice..........47
Key considerations to address respondent burden (CONCLUSION)........................................................49
WEEK 5: Costs.................................................................................................................................................50
I. Leusder, et al. (2023). Protocol for improving the costs and outcomes of assistive reproductive
technology fertility care pathways..............................................................................................................50
TDABC with observations and medical metro lines (phases 1-3)............................................................51
Process mining (phase 4)........................................................................................................................52
II. Leusder, et al. (2022). Cost measurement in VBHC: a systematic review................................................53
RQ1: Which costing methods are currently being used by practitioners to facilitate VBHC?..................54
RQ2: What are the consequences of applying these costing methods in VBHC? / How do they facilitate
VBHC?.....................................................................................................................................................55
III. Koster, et al. (2023). Dealing with Time Estimates in Hospital Cost Accounting: Integrating Fuzzy Logic
into Time-Driven Activity-Based Costing.....................................................................................................56
Time estimation of the activities in the process map (step 4) Fuzzy Logic .............................................57
Cost estimation of supplying patient care resources (step 5)..................................................................57
Estimation of the capacity of patient-specific resources & Calculation of the CCR (step 6)....................58
Total cost calculation of the RA care cycle (step 7)..................................................................................58
Time-Driven Activity-Based Costing (TDABC)..........................................................................................58
Activity-Based Costing (ABC)...................................................................................................................58
WEEK 6: Implementation aspects...................................................................................................................60
I. Amini, et al. (2021). Facilitators and barriers for implementing PROMs in clinical care...........................60
II. Damschroder, et al. (2022). The updated Consolidated Framework for Implementation Research based
on user feedback........................................................................................................................................63
Updated CFIR – overview of: domains, constructs and subconstructs....................................................65
2
, 2023-2024, Block 4 GW4014MV. Value Based Services
WEEK 1: Conceptualizing VBHC
I. Steinmann, et al. (2021). Expert consensus on moving towards a VBHC
system in the NL.
ABSTRACT
Objectives While the uptake of value-based health care (VBHC) is remarkable, uncertainty prevails regarding the most
important actions and practices in establishing a value-based healthcare system. In this paper, we generate expert consensus
on the most important aspects of VBHC. Design The Delphi technique was used to reach consensus on the most important
practices in moving towards a value-based healthcare system.
Setting and participants A Dutch expert panel consisting of nine members participated in a two-round survey.
Primary and secondary outcome measures We developed 39 initial items based on the pioneering literature on VBHC and
recent health policies in the Netherlands. Experts rated the importance of each item on a 4-point Likert scale. Experts could
change items or add new ones as they saw fit. We retained items that were rated (very) important by ≥80% of the panel.
Results After two survey rounds, 32 items (72%) were included through expert consensus. Experts unanimously agree on the
importance of shared decision-making, with this item uniquely obtaining the maximum score. Experts also reached
consensus on the importance of outcome measurements, a focus on medical conditions, and full cycles of care. No
consensus was reached on the importance of benchmarking.
Conclusion This paper provides new insight into the most important actions and practices for establishing a value-based
healthcare system in the Netherlands. Interestingly, several of our findings contrast with the pioneering literature on VBHC.
This raises the question whether VBHC’s widespread international uptake indicates its actual implementation, or rather that
the original concept primarily serves as an inspiring idea.
INTRODUCTION
The concept of value-based health care (VBHC) was pioneered by Porter and Teisberg, who propose an
overarching goal for all stakeholders in healthcare: to optimize value for patients. Thus far, however it
remains relatively unclear how to transition this popular idea into the actual establishment of a value-based
system; fragmented and muddled implementation efforts have been reported. Some attribute this to the
‘high level of abstraction’ and ‘vagueness’, but it could also be explained by its multifaceted composition:
VBHC was developed as a strategy that aims to inform all stakeholders in healthcare systems; its goal is
to ‘transform health care’.
In a value- based system, all stakeholders share a common objective: value for patients—with value
defined as a patient’s health status (outcomes) divided by the recourses it took to achieve that status
Outcomes
(costs). Value=
Costs
Value can only be understood at the level at which it is created. Providers should realign their
organisational structures, forming integrated practice units which focus on one or a few related
medical conditions and cover full care cycles.
Payment structures should also be aligned with value, with bundled payments for full cycles (or
episodes) of care.
Perhaps most importantly, providers should actively engage in benchmarking: hey should
systematically measure, report and compare their outcome data.
In sum, VBHC encompasses numerous aspects and requires a whole range of actions and practices in order
to be implemented.
AIM: we build on the Delphi method to identify the relative importance of various actions and practices in
moving towards a value- based system in the Netherlands.
RQ: which aspects, actions and practices do Dutch experts agree on as important in moving towards a
value- based healthcare system?
METHODS
3
, 2023-2024, Block 4 GW4014MV. Value Based Services
The Delphi technique is a well- established research method to build consensus where considerable
uncertainty exists, and where empirical evidence is (still) lacking. In this modified Delphi study, we explore
Dutch expert consensus on the most important aspects of VBHC, and the actions and practices that will
contribute to implement VBHC in the Dutch system.
- We recruited our expert panel through purposive sampling.
- We created an initial list of 39 items. The bulk of these items were derived from the pioneering
literature on VBHC. We complemented this with several items that—particularly within Dutch health
policy—are strongly related to VBHC. Accordingly, these items were extracted from policy documents
that directly deal with one or more aspects of VBHC.
- Our expert panel completed questionnaires during a two-round modified Delphi survey, in which they
rated each item according to ‘how important you deem this item in moving towards a value- based
healthcare system?’ Scoring occurred on a four-point Likert scale: (1) ‘very important’, (2) ‘important’,
(3) ‘moderately important’, (4) ‘not important’.
- After rating an item, each expert was asked whether they had suggestions to reformulate that particular
item. Additionally, by the end of the survey round, experts also had the possibility to add new items to
the list, as they saw fit.
- The second survey round consisted of both the reformulated and unchanged items that scored between
inclusion and exclusion, plus the newly suggested ones from round one.
- Since our goal was to generate consensus, we decided that only those items on which no consensus
was reached in the first round would be presented to the panel again in the second round.
RESULTS
First round:
20 items were rated as (1) or (2) by at least 80% of the panel members and therefore included.
6 items were rated (3) or (4) and therefore excluded.
No consensus was reached on 13 of our initial 39 items; of which 8 were reformulated.
5 new items were put forth by panel members.
Second round:
18 items were put forward; 5 unchanged, 8 reformulated, 5 new.
Of these, 12 items were included by the panel members.
Top 5 of the items:
After two rounds of questionnaires, 6 items remained on which no consensus could be reached. In other
words, these items were neither rated (very) important by ≥80% of the experts, nor were they rated
moderately or not important by ≥50%.
DISCUSSION
4
