PCV43 Assessing the VALUE in Cardiac Surgery with a Multi-Stakeholder Perspective: The Italian Cardiac Surgery VALUE Framework

Abstract

The sharp increase in healthcare costs in recent years has stimulated a flourishing debate on value and how to measure it. Numerous value frameworks for medical technologies were proposed. The aim of this work was to develop the first framework for cardiac surgery, proposing a set of performance measurement indicators. To achieve this goals, a composite methodology based on a mix of methods used in qualitative research (exploratory focus group, nominal group technique and confirmatory focus group) was applied to discuss and find a consensus on the relevant dimensions of value of cardiac surgery life-saving technologies. In order to bring a multi-stakeholder perspective, the discussion involved an expert panel of all the relevant stakeholders, including cardiac surgeons, policymakers, hospital managers, patients and their representatives, contracting authorities, academia, and the industry. Five dimensions of value were identified: appropriateness, effectiveness, quality of life, technical efficiency, and economic aspects. Several key performance indicators were defined within each dimension together with the set of information (i.e., data on inputs, outputs, outcomes and costs) and the level of detail (i.e., patient, ward, hospital, region) necessary to calculate the indicators. The final output is a multidimensional key performance measures dashboard aimed to allow a benchmarking across hospitals and areas, supporting evidence-based decisions regarding resource allocation. Thanks to the implementation of the framework, the policymakers will get a clear picture of cardiac surgeries output, level of innovativeness, resources dedicated to care and patient outcomes. Discussion of the results will allow to identify best practices to converge and support continuous benchmarking across time and centres.