Healthcare Value Research Articles

"Room of Horrors": A Proof-of-Concept Simulation Model for Error Reduction Training in the Emergency Department.

This pilot study aimed to assess the effectiveness of a "room of horrors" (RoH) simulation in identifying patient safety threats in a pediatric emergency department (PED) and to evaluate health care workers' (HCWs') perceptions of the experience. We developed an RoH simulation featuring 25 potential safety hazards derived from actual PED incidents and "never events." The teams of physicians and nurses who participated in the simulation identified as many hazards as they could within a 10-minute window followed by a debriefing session during which errors were corrected and missed hazards were pointed out. The participants' perceptions were measured on a 5-point Likert scale of a questionnaire. Twenty sessions that included a total of 45 participants were conducted. The teams identified an average of 23 of 25 safety threats, yielding a mean detection rate of 86% for electronic medical record errors, 95% for physical space errors, and 97% for communication errors. The simulation received high ratings for overall positive experience (4.88/5) and impact on daily activities (4.68/5). The RoH simulation experience was effective in evaluating the level of retention of earlier training and the ability of multidisciplinary teams to correctly identify major safety threats in a PED setting. The participants found the experience valuable and engaging. Future research should focus on other means by which the retention of learned skills can be reinforced and new safety threats can be identified with a high level of alertness.

The Tango to Modern Collaboration and Patient-Centric Value Generation in Health Care – a real-world guide from practitioners for practitioners

Background Value-Based Health Care (VBHC) represents a pivotal shift from volume-based to outcome-driven quality metrics centered on patient-valued outcomes. This approach requires collaboration across all participants in the health care value chain; providers, payers, pharma, policymakers and patients (collectively known as the 5Ps). Despite substantial theoretical endorsement of VBHC’s potential for improving health outcomes and system efficiency, empirical evidence detailing its practical implementation remains limited. This field study evaluates the real-word implementation of VBHC within a health care organization. Methods In 2022, a health care collaboration Think Tank initiated this investigation during a breakout session, gathering insights from 12 leading international organizations to construct an empirical VBHC transformation reference guide. Real-world data was collected through structured interviews over a 1-year period, covering the 5 P value chain in various healthcare settings. The VBHC initiatives were analyzed through four stages: initiation, data acquisition, collaborative frameworks, and results evaluation. Results The 12 interviews identified five key enablers for successful VBHC implementation: 1. Organizational Purpose: defining core motivators for change; 2. People: identifying pivotal roles and leadership to endorse change; 3. Resources: securing personnel and financial support; 4. Data Infrastructure: developing interoperable IT systems for effective data sharing and collection; 5. Execution: prioritizing sustained implementation processes. Conclusion The findings highlight that VBHC implementation and adoption is complex and requires incremental advancements, dedicated leadership, and resilient strategic framework spanning over multiple years. A comprehensive understanding of patient populations, risk stratification, and appropriate outcome metrics are essential to measure and deliver the VBHC transformation. Executive endorsement and transition funding during the transformation process are paramount to support this systemic shift. Collaboration among all 5 P stakeholders is essential for success. This field study underscores the importance of continuous learning and adaptation, providing a practical guide to enhance health care quality and efficiency that serves all stakeholders.

Diagnostic accuracy of artificial intelligence for the screening of prostate cancer in biparametric magnetic resonance imaging: a systematic review

BACKGROUND: Based on the latest published data, 40,137 new cases of prostate cancer were reported in Russia in 2021, ranking second after lung cancer in men. Thus, prostate cancer is one of the most common malignant neoplasms in men. Accurate and timely detection of prostate cancer is important under the current conditions. AIM: This systematic review aimed to assess the quality of prediction models designed to detect prostate cancer during initial presentation. MATERIALS AND METHODS: A systematic search was performed in eLibrary.ru, PubMed, Google Scholar, Web of Science, and ResearchGate for relevant publications indexed from January 2019 to September 2023 in accordance with the PRISMA protocol. Two authors independently assessed the relevant studies for potential inclusion or exclusion. RESULTS: This systematic review meta-analysis included 21 studies. In total, data from 3,630 patients were analyzed, of which 47% had prostate cancer and 53% had benign prostate neoplasms. The mean age of the patients was 67.1 (36–90) years. In addition, 81% of the studies were based on T2-weighted imaging, 57% on diffusion-weighted imaging, and 76% on apparent diffusion coefficient. Moreover, 43% and 33% of the studies were dedicated to transition zone and prostate peripheral zone neoplasms, respectively, and 52% of the authors examined the whole prostate gland, without dividing it into zones. The most common machine-learning algorithms applied by the investigators were as follows: multiple logistic regression (76%), support vector machine (38%), and random forest (24%). Based on the meta-analysis performed for the receiver operating characteristic-area under the curve (ROC–AUC) assessment with random-effect approach in 73 prediction models described in the publications, the final ROC–AUC was 0.793 [95% CI 0.768–0.818], I2 = 86.71%, p 0.001. The most accurate prediction models were based on the T2-weighted imaging + apparent diffusion coefficients imaging protocol: 0.860 [95% CI 0.813–0.907], and models created according to the “white box” principle (0.834 [95% CI 0.806–0.861]) were more accurate than the “black box” ones (0.733 [95% CI 0.695–0.771]). The models using radiomics and clinical features were slightly more accurate than those using the radiomics parameters alone (0.869 [95% CI 0.844–0.895] vs. 0.779 [95% CI 0.751–0.807]). Model accuracy was nearly identical across transitional and/or peripheral zone studies. CONCLUSIONS: Artificial intelligence demonstrated promising results. However, the clinical applicability may require more intensive expert inspection in healthcare institutions and evaluation of efficacy in prospective studies.

Visual decision aids to support communication and shared decision-making: How are they valued and used in practice?

It is unknown how visual decision aids support communication and shared decision-making in everyday clinical practice, and how they are perceived by patients with varying levels of health literacy and their healthcare providers. Recently, three visual decision aids have been developed for renal replacement treatment, osteoarthritis of the knee, and osteoarthritis of the hip. This study aims to explore how patients and healthcare providers use and value these visual decision aids. The evaluation of the visual decision aids was performed by coding video-recorded outpatient consultations (n = 35), by conducting reflective practice interviews with healthcare providers (n = 9), and through interviews with patients (n = 29). Consultations were coded using the 5-item OPTION instrument to measure shared decision-making, and self-developed items based on the visual decision aids and user guide. Both healthcare providers and patients valued the use of the visual decision aids, especially the overview page with all treatment options. Accordingly, it was observed that most providers mainly used the overview page. However, providers in nephrology discussed the individual treatment pages more often than providers in osteoarthritis care. This study also showed that most providers were unfamiliar with the user guide for the visual decision aids. Visual decision aids for nephrology and osteoarthritis care seem particularly useful for patients with limited health literacy. Healthcare providers in this study mainly used the overview page of the visual decision aids. Although this is valued by both providers and patients, it is also important to discuss the individual treatment pages, including the pros and cons, with patients. This study also points to differences between outpatient clinics or departments in the use and implementation of the visual decision aids. The visual decision aids for osteoarthritis are used to a limited extent. In nephrology clinics, the visual decision aid is implemented.

The value of a neurosurgeon: is neurosurgical compensation proportional to value added? A systematic review of the literature and an update on a changing healthcare economy.

Determining the value of a neurosurgeon is complex. Services provided by neurosurgeons have a range of interested parties-from a patient's singular health interest to a community catchment area rendering on-call emergency services. Such complexity makes it difficult to determine and define value. As healthcare reimbursement changes continue to transition further toward value-based/bundled payments, such determinations remain difficult and confusing. Given these factors, now more than ever before, neurosurgeons need to be active participants in the evolving discussions surrounding healthcare advocacy, value, and compensation in an ever-evolving and convoluted system. The objective of this study was to review and present current trends within the evolving landscape of healthcare economics and their impacts on the perceived value of neurosurgical services. A systematic review regarding payments and compensation within neurosurgery was performed using a key term search. Additionally, a neurosurgical value model for hospitals was created using Medicare reimbursement methods to attempt to determine the financial contribution of a single neurosurgeon to a hospital system. Furthermore, Internal Revenue Service (IRS) form 990 tax filings from 5380 organizations were examined for comparative trends in profits and revenue on a hospital-wide basis. Mean and median annualized excess hospitalization revenue from a neurosurgeon over the same number of equal medical admissions was $5,120,533 and $5,141,160, respectively. For private practice groups, the annualized mean and median yearly hospital revenue over a comparable medical admission was calculated to be $1,539,704 and $1,902,555, respectively. For hospital-employed neurosurgeons, the respective addition of Medicare part B payments increased the mean and median values to $2,249,552 and $2,612,403, respectively. Analysis of nonprofit hospital IRS form 990 filings revealed a substantial increase in executive compensation and hospital revenue since 2011. Neurosurgeon median earnings over a similar period, reported through surveys, exhibited varied increases, but significant reporting variation exists. Medical compensation continues to evolve toward more value-driven methods. Value created as a neurosurgeon is complex, but it should not be underestimated as a key driver of hospital revenue, with up to $2.6 million created annually from neurosurgical hospital admissions. Further discussion is needed to elucidate alternative innovative payment strategies to ensure physicians remain active in the evolving structure of our healthcare system.

Achieving Healthcare Value through Care Plan Accountability

U.S. medical costs continue to outpace the GDP despite the introduction of multiple accountable care efforts established to reduce unnecessary expenditures. These increasing costs have a negative impact on patients who are experiencing increased out-of-pocket expenses as well as employers who must shoulder a large part of the healthcare cost burden. While there are multiple societal factors contributing to the rising medical costs, our healthcare system can play a more effective role in addressing this problem. This role begins with fundamental changes to our reimbursement systems placing an emphasis on individual plans of care and adding greater accountability through free market controls. A comprehensive plan of care lays out the roles of care plan participants across medical, social, and behavioral services with a corresponding budget covering all the services provided as well as the expected outcomes from each service. An initial free market control is patient authority to accept or reject the plan of care with a corresponding financial responsibility for compliance in care plan execution. The elements of provider accountability include a public provider performance reporting system across quality, costs and patient satisfaction factors as well as a reimbursement system that incentivizes effective care planning and execution. This shift in focus from incremental care to care planning and execution combined with the institution of pro-competitive and financial accountability measures is expected to bring greater value to healthcare by improving patient outcomes while reducing medical costs.

How clinical ethics discussions can be a model for accommodating and incorporating plural values in paediatric and adult healthcare settings.

The following text is the de-identified and edited transcript of an invited presentation by Professor Clare Delany on the topic of 'How clinical ethics discussions can be a model for accommodating and incorporating plural values in paediatric and adult healthcare settings.' Professor Delany's presentation formed part of the Conference on Accommodating Plural Values in Healthcare and Healthcare Policy, which was held in Melbourne, Australia, on Monday, October 30, 2023. This conference was a key output of the Australian Research Council Discovery Project grant DP190101597, 'Religion, pluralism, and healthcare practice: A philosophical assessment'. Professor Delany's presentation was introduced by Doctor Lauren Notini, Research Fellow and Lecturer at Monash Bioethics Centre, Monash University.

Developing an Index to Measure the Value of Health Care Provided to Stroke Patients.

It is possible to evaluate health services for stroke patients based on clinical benefits. However, in recent years, questions about responsiveness and outcomes have also emerged. Currently, there is no index that can assess health-care services for stroke patients along these three dimensions. This study introduces the first index designed to measure the value generated by health-care services for stroke patients. The Case-Mix Variables Data Collection Reference Guide, developed through a review of national and international stroke guidelines, underwent content validation by 10 neurologists and 10 interventional radiologists. Questions with a content validity index exceeding 0.80, along with the World Health Organization responsiveness questionnaire and the Patient-Reported Outcomes Measurement Information System Global-10 short form, were subjected to pairwise comparison by two neurologists, two interventional radiologists, and two public health physicians using the analytic hierarchy process (AHP) method. In the comprehensive ranking of questions formulated using the AHP method and assessed by experts for importance and global weights, new stroke follow-up emerged as the most crucial, garnering an index score of 0.09. Conversely, questioning patients about their alcohol use status was deemed the least significant by experts, registering an index score of 0.00021. Our AHP analyses have furnished an index for gauging the factors that contribute to the value of health-care services rendered to stroke patients.

Enhancing medical education through personal enrichment competency modules: Integrating multifaceted skills for modern healthcare practice

The implementation of Personal Enrichment Competency (PEC) modules in medical education curricula should be recognized as an initiative that is geared towards developing students’ multifaceted skills and assets which would be required in modern medical practice. PEC modules will be implemented using an integrated approach which suggests putting content in different subjects and making the PEC concepts part of both medical and health science courses for students to have experiential learning experiences. Emphasis is put on strategies that motivate active learning, involving, for example, interactive lectures, case-based discussions, role-playing activities, games and project tasks, to generate engagement and comprehension of key competencies. Disciplines from the same healthcare but from various programs have an opportunity to share ideas through the multidisciplinary teams which develops teamwork, communication, and respect for diverse perspectives within institutions. The continuous assessment and improvement make sure that the PEC modules are always up to date, problem-solving as well as answering the ever-changing requirements of the healthcare field. Institutions can achieve this goal through regular feedback mechanisms and assessment of students' knowledge and skills data, which will help them find limitations in the PEC programs and improve their modules to make them work well in the field of modern medical practice. Lastly, incorporating PEC modules into the curriculum helps students gain the advanced skills of teamwork, leadership, communication, ethics and values in healthcare. Overall, they are well equipped to excel in the delivery of patient-centred care in different clinical settings after their training. Such a study gives essential findings to medical education resources who are striving to improve their curricula to be able to upskill future healthcare professionals to embrace the demands of current medical practice.

Health care utilization and costs among coordinated care patients in Southeastern Ontario: A difference-in-differences study of a double propensity score-matched cohort.

Coordinated care plans (CCPs) for high-cost health care system users aim to improve system-level performance. We evaluated health care resource use and costs among CCP patients (enrollees) versus a control group that did not receive coordinated care (comparators) in Southeastern Ontario. A difference-in-differences analysis of a quasi-experimental, double propensity score-matched and adjusted cohort was conducted. Linked population-based administrative data were used to measure health care utilization and costs and to identify comparators for two enrollee groups who began CCPs between April 1, 2013, and March 31, 2019. Enrollees were recruited from hospitals in Quinte or community care centres in Rural Hastings/Thousand Islands, and were 1:1 propensity score matched to comparators. Difference-in-differences estimates were calculated using generalized estimating equations for hospitalization rates, homecare visits, primary care visits, other health care resources and total costs. A total of 558 enrollees in Quinte and 538 in Rural Hastings/Thousand Islands were identified and matched to comparators. Difference-in-differences estimates were significant in both enrollee groups for number of homecare visits ([IRR 1.72; 95% CI (1.44, 2.06)] and [IRR 1.73; 95% CI (1.45, 2.06)], respectively). Number of primary care visits were 1.76 times greater for Rural Hastings/Thousand Islands enrollees versus comparators [IRR 1.76; 95% CI (1.32, 2.35)]; total costs increased by 23% ([IRR 1.23; 95% CI (1.09,1.39)]. Homecare use significantly increased for enrollees versus comparators, indicating specific priority areas of Ontario CCPs were met. However, no reductions were shown for other health system performance indicators. We also showed increased 7-day primary care follow-up visits for community care centre-recruited patients, but not for hospital-recruited patients. Decision-makers may wish to target patients who are less advanced in their chronic disease trajectory.

Exploring Reentry Concerns of Incarcerated Individuals with Severe Mental Illness.

Little is known about the factors and circumstances that relate to how incarcerated individuals with serious mental illness (SMI) view their own needs upon reentry and their ability to meet them. In this study, 101 imprisoned adults with SMI rated their level of concern over meeting their basic needs and obtaining services following incarceration. Greater reentry concern was predicted by anticipated barriers to psychological care and increased psychological distress. When participants were asked what factors concerned them most, 51% identified housing, 41% financial concerns, and 39% obtaining services. The extent level of concern related to recidivism (rearrest during the 6-month follow-up post-release) was also examined; no significant relationship was observed. Findings align with prior research, suggesting that there should be less emphasis on convincing individuals of the value of mental health care and a greater focus on how to help them meet other demands that may prevent them from seeking such services.

Alignment of Audiologists' Values With Best-Practice Standards: Insights From a National Survey.

Previous research documented the values of audiology through a qualitative content analysis of documents representing traditional, best-practice hearing health care. The primary objective of this study was to validate the existing list of audiology values. Through a nationwide survey, this study aimed to elicit the values of practicing audiologists, with a specific focus on the prescription and dispensing of amplification devices, to ensure a comprehensive understanding of their priorities. Additionally, this study sought to identify any values missing from the original list and determine the rank order importance of these values, comparing this to the prioritization of values found in best-practice audiology documents. This comparison aimed to assess the alignment of recommended guidelines and real-world practices in hearing health care. An online survey was distributed to audiologists to elicit the prioritization of values from hearing health care providers. Participants were tasked with sorting and ranking 18 items, each representing a specific value in hearing health care, based on importance. Respondents were encouraged to suggest and rank the importance of additional values not included in the list. Audiologists were recruited from professional association mailing lists and direct contact. Respondent demographics were representative of U.S. audiologists. Qualitative content analysis was used to interpret values suggested by audiologists. Kendall's rank distance test was used to compare values prioritization between audiologists and best-practice audiology documents. After filtering out incomplete or disqualifying responses, data from 289 audiologists across 46 states were analyzed. Additional values suggested by respondents aligned with existing values from best-practice documents; thus, no new values were added as a result of this study. A ranked list of values based on mean order of importance was elicited from U.S.-based audiologists. There was substantial agreement between survey results and the rank order of values found in best-practice audiology documents. A demographic subgroup analysis revealed a broad agreement among audiologists in the rank order of values. This study validated a comprehensive list of values in audiology and identified the rank order of values among a nationally representative sample of audiologists. The findings provide a foundation for future investigations into how these values influence decision-making processes for individuals with hearing difficulty. Addressing values conflicts as potential barriers to hearing health care usage can lead to solutions aligned with values of specific populations, ultimately improving the adoption and effectiveness of hearing health care interventions. https://doi.org/10.23641/asha.27478149.

What are the priorities of consumers and carers regarding measurement for evaluation in mental healthcare? Results from a Q-methodology study

BackgroundThe purpose of this study was to identify and describe common views of people with lived experience of mental health challenges – consumers and carers, families and supporters – of what they consider the most important measures to include in health economic evaluations which assess the incremental value of competing options in mental health care.MethodsParticipants (n = 111) were people living in the state of Victoria, Australia, who identified as consumers of mental healthcare (n = 38); carers, family members and/or supporters (n = 43); or both (n = 30). Factor analysis based on Q-Methodology was used to identify clusters of people who hold similar viewpoints. Common viewpoints were described in terms of the characteristics of the group, and a qualitative interpretation was conducted on the basis of distinguishing statements and quotes provided in participants’ own words.ResultsWe identified four common views: (1) safety before all else, prioritizing physical, sexual and psychological safety; (2) hope and partnership in processes of care; (3) physical and emotional health and wellbeing; and (4) care access, continuity and partnership with families. Although different priorities were identified for each viewpoint, key priority areas that were common to all views were having an environment in the health service that fosters respect and dignity, and that consumers feel heard and listened to. In sub-group and qualitative analyses, differences were observed regarding the likelihood of consumers and carers holding each of the views, as well as by age group.ConclusionsWhile some differences were noted between the views of consumers and carers and different age groups, there was also common ground regarding what outcomes are of most importance to measure. Including these measures in evaluation frameworks would provide a way of focussing mental healthcare decisions on the aspects of mental healthcare that are of most value to consumers and carers, thereby addressing an important shortcoming of current approaches to decision-making in mental healthcare.

Patient Health Record Protection Beyond the Health Insurance Portability and Accountability Act: Mixed Methods Study.

The security and privacy of health care information are crucial for maintaining the societal value of health care as a public good. However, governance over electronic health care data has proven inefficient, despite robust enforcement efforts. Both federal (HIPAA [Health Insurance Portability and Accountability Act]) and state regulations, along with the ombudsman rule, have not effectively reduced the frequency or impact of data breaches in the US health care system. While legal frameworks have bolstered data security, recent years have seen a concerning increase in breach incidents. This paper investigates common breach types and proposes best practices derived from the data as potential solutions. The primary aim of this study is to analyze health care and hospital breach data, comparing it against HIPAA compliance levels across states (spatial analysis) and the impact of the Omnibus Rule over time (temporal analysis). The goal is to establish guidelines for best practices in handling sensitive information within hospitals and clinical environments. The study used data from the Department of Health and Human Services on reported breaches, assessing the severity and impact of each breach type. We then analyzed secondary data to examine whether HIPAA's storage and retention rule amendments have influenced security and privacy incidents across all 50 states. Finally, we conducted a qualitative analysis of textual data from vulnerability and breach reports to identify actionable best practices for health care settings. Our findings indicate that hacking or IT incidents have the most significant impact on the number of individuals affected, highlighting this as a primary breach category. The overall difference-in-differences trend reveals no significant reduction in breach rates (P=.50), despite state-level regulations exceeding HIPAA requirements and the introduction of the ombudsman rule. This persistence in breach trends implies that even strengthened protections and additional guidelines have not effectively curbed the rising number of affected individuals. Through qualitative analysis, we identified 15 unique values and associated best practices from industry standards. Combining quantitative and qualitative insights, we propose the "SecureSphere framework" to enhance data security in health care institutions. This framework presents key security values structured in concentric circles: core values at the center and peripheral values around them. The core values include employee management, policy, procedures, and IT management. Peripheral values encompass the remaining security attributes that support these core elements. This structured approach provides a comprehensive security strategy for protecting patient health information and is designed to help health care organizations develop sustainable practices for data security.

Assessing the contributions of gender, clinical symptoms, and psychometric traits to non-suicidal self-injury behaviors in Chinese adolescents: a nomogram approach.

Non-suicidal self-injury (NSSI) behaviors among adolescents with mood disorders represent a significant global public health concern. This study aimed to assess the prevalence and identify key predictors of NSSI behaviors in Chinese adolescents diagnosed with depressive or bipolar disorders, addressing a critical gap in the literature. Data from 2343 participants in the Chinese Adolescent Depression Cohort (CADC) were analyzed. The study employed a comprehensive approach, utilizing medical records, clinical assessments, and validated psychometric instruments. Statistical analyses included chi-square tests, logistic regression, and ROC curve analyses, culminating in the development of a predictive nomogram. The prevalence of NSSI behaviors was strikingly high at 73.32%. Significant predictors included female gender (AOR = 2.14, 95% CI [1.70, 2.68]), presence of hallucinations (AOR = 1.52, 95% CI [1.18, 1.97]), borderline personality features (AOR = 1.03, 95% CI [1.01, 1.08]), and childhood trauma (AOR = 1.02, 95% CI [1.01, 1.03]). The study's key contribution is a predictive nomogram with an AUC of 0.74, demonstrating good efficacy in predicting NSSI behaviors. This research reveals an alarmingly high prevalence of NSSI behaviors in Chinese adolescents with mood disorders and identifies critical predictors spanning demographic, clinical, and psychometric domains. The developed nomogram offers a novel approach for risk assessment, highlighting the importance of comprehensive evaluations in adolescent mental healthcare. These findings have significant implications for developing targeted interventions and improving risk assessment strategies in clinical practice.

The impact of a payer-provider joint venture on healthcare value.

To examine how a novel payer-provider joint venture (JV) between one payer and multiple competitive delivery systems in New Hampshire (NH), which included value-based payment, care management, and non-financial supports, impacted healthcare value and payer and provider group experiences. We conducted a mixed-methods study. We used a quasi-experimental longitudinal difference-in-differences design to examine the impact of the JV (which started in January 2016 and ended in December 2020) on healthcare utilization, quality, and spending, using members in Maine (ME) as a control group. We also analyzed patient uptake of the JV's care management program using routinely collected administrative data and assessed payer and provider group leaders' perspectives about the JV via semi-structured interviews. We used administrative and claims data from 2013 to 2019 in a commercially insured population under 65 years in NH and ME. We also used administrative data on care management eligibility and uptake and conducted semi-structured interviews with payer and provider group leaders affiliated with the JV. The JV was associated with no sustained change in medical utilization, quality, and spending throughout the study period. In the first year of the JV, there was a $142 (95% confidence interval: $41, $243) increase in pharmaceutical spending per member and a 13% (4.4%, 25%) relative increase in days covered for diabetes medications. Only 15% of eligible members engaged in care management, which was a key component of the JV's multi-pronged approach. In a disconnect from the empirical findings, payer and provider group leaders believed that the JV reduced healthcare costs and improved quality. Our findings provide evidence for future payer-provider JVs and demonstrate the importance of having a valid control group when evaluating JVs and value-based payment arrangements.

Healthcare Value Assessment: A Critical Review of Economic Outcome Metrics and Future Directions

This paper provides a critical review of economic outcome metrics used in healthcare value assessment, emphasizing the evolving landscape of resource allocation, patient-centered approaches, and standardization efforts. With healthcare costs rising globally, the efficient allocation of limited resources is essential. Metrics like Quality-Adjusted Life Years (QALYs), Disability-Adjusted Life Years (DALYs), Incremental Cost-Effectiveness Ratios (ICERs), and Cost-Benefit Analysis (CBA) are central to guiding funding decisions, influencing insurance coverage, and shaping treatment prioritization. Emerging trends, such as the integration of artificial intelligence (AI) and big data, are enhancing the precision of these assessments, while patient-centered metrics underscore the importance of patient satisfaction and quality of life. Additionally, there is a growing push for the standardization of these metrics to create consistent frameworks across diverse health systems. This paper explores case studies, practical applications, and future directions to provide insights into how healthcare systems can adopt more effective, globally aligned economic assessments.

Evaluating healthcare inequalities using ChatGPT4 – The case of potentially inappropriate medication

Abstract Issue/problem Regular and standardized monitoring of healthcare is necessary to inform decision makers and clinicians about healthcare quality. Equity is a fundamental dimension in such evaluations. We aimed to investigate if artificial intelligence (AI) large language models (LLM), such as ChatGPT4, may facilitate routine monitoring of healthcare inequalities using an established framework for healthcare quality and equity evaluation, analysis of individual heterogeneity and discriminatory accuracy (AIHDA). Description of the problem We have previously demonstrated that compared to traditional methods, AIHDA improves the evaluation of healthcare inequity. We asked ourselves if ChatGPT4 could facilitate the standardized application of the AIHDA approach in routine monitoring of healthcare. Results Using strict guidelines, we instructed a GPT model, based on ChatGPT 4, to utilize the AIHDA framework for evaluating healthcare inequalities. To demonstrate the analysis, we used the quality indicator potentially inappropriate medication among elderly and analyzed simulated data of individuals >75-year-old belonging to 36 socioeconomic strata and residing in 21 Swedish regions. The GPT performed an accurate analysis, correctly interpretated the results and formulated an informative short rapport with illustrative tables and figures. Lessons AI appears to facilitate routine monitoring of health care inequity using the AIHDA approach. AI also allows a constructive interaction with the user but, so far, it needs be closely supervised. Key messages • ChatGPT 4 can improve the standardized evaluation of healthcare inequity. • Although the technology is under development and must be used with caution.

The importance of healthcare monitoring systems

Abstract Issue Healthcare evaluation is an important tool of governance in the health sector that reinforces its key components: evidence-based care, effectiveness, programme standards, performance monitoring, quality improvement, risk and incident management and patient-centered care. One of the evaluation systems used by the Veneto Region (north italian region of about 4.8 million inhabitants) consists of the National Outcomes Programme (PNE) developed by the Italian National Agency for Regional Healthcare Services (AGENAS) on behalf of the Health Ministry. Description The PNE is an instrument used to measure, analyze, evaluate and monitor clinical and welfare assistance performances of Italian healthcare facilities. The Veneto Region, in particular, utilizes a regional epidemiologic service to periodically monitor 21 performance indicators based on “treemap” methodology. These indicators are used to assess processes, outcomes and volumes. The data used to monitor these practices derive from the hospital discharge documentation (SDO) and tax registry information system. The aim of this monitoring system is to track any critical situation that is not in alignment with national guidelines and to improve the efficacy, efficiency, appropriateness and safety within the healthcare system. Results In the Veneto region, over the course of nearly 10 years, this method of management has led to the development of various training courses that guide clinicians to correctly document and code different diagnosis and treatments. The treemap process of analysis has also made possible various clinical audits that have provided significant policy changes regarding risk and overall health management. Lessons Having a constant view of healthcare performance has proven to be helpful not only to identify some common gaps in care given from different facilities on a national level, but also guides different regions to develop specific strategies that lead to quality improvement. Key messages • Data on healthcare quality can be used as comparative information and for quality improvement. • Continuous monitoring of specific performance indicators can help identify difficulties in healthcare facilities and create strategies for long term solutions.

Hospital productivity and value in pay-for-performance healthcare programs

ABSTRACT Pay-for-performance (P4P) reimbursement models were launched in 2013 to incentivise the value of healthcare delivered by including quality outcomes, such as mortality, readmission, and patient satisfaction, in hospital reimbursement in the U.S. Although a decade has passed, the efficacy of these P4P programs remains unclear. This research intends to evaluate their long-term performance implications along two critical dimensions – productivity and healthcare value. Drawing on a nationwide sample of U.S. hospitals collected from 2008 to 2019, we utilise data envelopment analysis to measure hospital performance and the Malmquist index to evaluate their longitudinal trends. Although average hospital productivity and value improved since the rollout of the P4P programs, we observe that a large proportion of laggard hospitals were unable to catch up with improvements to the performance frontier, raising concerns about disparities in the impact of future value-based programs. Our analyses also indicate that horizontal integration across hospitals is associated with greater productivity and value. While greater physician-hospital (vertical) integration is associated with higher hospital productivity, it does not have a positive impact on value. Our study provides new insights into the antecedents and performance consequences of implementing value-based healthcare initiatives and their implications for hospital managers and policymakers.