Tackling the frailty burden with an integrative value-based approach: results from a mixed-methods study

Daniel Fürstenau,Tim Walz,Moritz Höft,Hannah Haneke,Rudolf Mörgeli,Claudia Spies,Felix Balzer,Kai Schewina

doi:10.1007/s10389-021-01647-2

Abstract

AimThe purpose of this paper is to investigate the implementation of value-based care principles in the context of frailty in the perioperative process, highlighting the importance of an integrative perspective considering medical and patient-centric outcomes as well as costs.Subject and methodsThis mixed-methods study employs a sequential design. Qualitative observational data were used to identify needs and barriers for implementing value-based principles, and quantitative methods were subsequently used to demonstrate the value of employing such an approach using data gathered from n = 952 patients. Propensity score matching was applied to identify the frailty-associated costs of the inpatient setting for n = 381 non-frail and n = 381 (pre-)frail patients, in particular considering patient-centric outcomes.ResultsThe qualitative analysis identified three main challenges when implementing value-based principles in the context of perioperative care and frailty, namely challenges related to the cost, patient-centric, and integrative perspectives. In addressing these shortcomings, a quantitative analysis of a propensity score-matched sample of patients undergoing surgery shows additional frailty-associated costs of 3583.01 [1654.92; 5511.04] EUR for (pre-)frail patients and the influence of individual patient-centric attributes. Effect size Cohen’s d was 0.26.ConclusionThe results demonstrate that frailty should be considered from an integrative perspective, taking cost, patient-centered outcomes, and medical outcomes into account simultaneously. The results also show the value of a research design which uses qualitative data for the identification of needs and barriers, as well as quantitative data for demonstrating the usefulness of the conceived value-based approach to perioperative care delivery.

Highlights

Frailty is a multidimensional syndrome commonly occurring among elderly people, which manifests itself through an increased vulnerability to stressors, which results in ageassociated decline of one’s physical and psychological reserves (Xue 2011)
The purpose of this paper is to investigate the implementation of value-based health care principles in the context of frailty in the perioperative process
The results show that the clinical frailty status is associated with significantly higher in-patient treatment costs across several categories of age, gender, body mass index (BMI), Barthel Index, Charlson Comorbidity Index (CCI), surgical discipline, smoking status, polypharmacy, and happiness

Summary

Introduction

Frailty is a multidimensional syndrome commonly occurring among elderly people, which manifests itself through an increased vulnerability to stressors, which results in ageassociated decline of one’s physical and psychological reserves (Xue 2011). Especially frailty-associated complications, has been increasingly referred to, underlining its importance for evaluating and enhancing the functional status of patients in situations associated with great stressors. J Public Health (Berl.): From Theory to Practice understanding of the individual physical and psychological resources of patients in critical situations (Birkelbach et al 2019). Frailty is associated with higher occurrence of surgical-related complications, including the need to be discharged to an ICU, deeper sedation, and breathing aids— thereby substantially increasing the risk of worsened postoperative outcomes (Birkelbach et al 2019)

Objectives

Methods

Results

Discussion

Conclusion