First insights on value-based healthcare of elders using ICHOM older person standard set reporting

Wei-Ju Lee,Ching-Hui Loh,Shinn-Zong Lin,Liang-Kung Chen,Chun-Feng Huang,Chi-Hung Lin,Chia-Yun Chang,Sheng-Lun Kao,Ting-Ching Tang,Tzu-Shing Hung,Li-Ning Peng

doi:10.1186/s12877-020-01734-1

Abstract

BackgroundClinical guidelines for specific conditions fragment care provision for elders. The International Consortium for Health Outcomes Measurement (ICHOM) has developed a global standard set of outcome measures for comprehensive assessment of older persons. The goal of this study was to report value-based health metrics in Taiwan using this ICHOM toolset.MethodsThe cross-sectional study of baseline data excerpted from a prospective longitudinal cohort, which recruited people ≥65 years old with ≥3 chronic medical conditions between July and December 2018. All participants received measurements of physical performance, anthropometric characteristics, health-related behaviors, Charlson Comorbidity Index, and Montreal Cognitive Assessment. The ICHOM toolset comprises three tiers: 1 includes frailty and having chosen a preferred place of death; 2 includes polypharmacy, falls, and participation in decision-making; and 3 includes loneliness, activities of daily living, pain, depression, and walking speed. These items were converted into a 0–10 point value-based healthcare score, with high value-based health status defined as ≥8/10 points.ResultsFrequencies of individual ICHOM indicators were: frail 11.7%, chose preferred place of death 14.4%, polypharmacy 31.5%, fell 17.1%, participated in decision-making 81.6%, loneliness 26.8%, limited activities of daily living 22.4%, pain 10.4%, depressed mood 13.0%, and slowness 38.5%. People with high disease burden (OR 0.40, 95% CI 0.21–0.76, p = 0.005) or cognitive impairment (OR 0.49, 95%CI 0.27–0.87, p = 0.014) were less likely to have high value-based healthcare status.ConclusionsThe ICHOM Standard Set Older Person health outcome measures provide an opportunity to shift from a disease-centric medical paradigm to whole person-focused goals. This study identified advanced age, chronic disease burden and cognitive impairment as important barriers to achieving high value-based healthcare status.

Highlights

Clinical guidelines for specific conditions fragment care provision for elders
This study explored the application of the International Consortium for Health Outcomes Measurement (ICHOM) Standard Set for Older Persons health status among older multi-morbid community-dwelling adults in Taiwan
For every year increase in age, the likelihood of achieving high valuebased healthcare status decreased by 5%. (Table 5)

Summary

Introduction

Clinical guidelines for specific conditions fragment care provision for elders. A single-disease model has prevailed over centuries of medical progress, but the era of population aging brings major challenges of managing multimorbidity in older adults that threaten to fragment care provision by necessitating multiple assessments and treatments [1]. Healthcare systems will be increasingly burdened by fragmented services, higher service volumes and escalating associated medical costs, and are transitioning from volume-based to value-based provision that emphasizes quality, expenditure and patient experience [2]. Specific models of value-based healthcare, such as pay-for-performance, have shown effectiveness in certain diseases or chronic conditions but not overall [3]. Prevalent chronic comorbidities in older adults [1] make it hard to measure variations in health outcomes. More ‘function-centric’ aging medicine is crucial to handling the diversity and complexity of health care for older people and promoting healthy aging [4]

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