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van Engen V, Buljac-Samardzic M, Baatenburg de Jong R, Braithwaite J, Ahaus K, Den Hollander-Ardon M, Peters I, Bonfrer I. A decade of change towards Value-Based Health Care at a Dutch University Hospital: a complexity-informed process study. Health Res Policy Syst 2024; 22:94. [PMID: 39103922 DOI: 10.1186/s12961-024-01181-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 07/13/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND While healthcare organizations in several countries are embracing Value-Based Health Care (VBHC), there are limited insights into how to achieve this paradigm shift. This study examines the decade-long (2012-2023) change towards VBHC in a pioneering Dutch university hospital. METHOD Through retrospective, complexity-informed process research, we study how a Dutch university hospital's strategy to implement VBHC evolved, how implementation outcomes unfolded, and the underlying logic behind these developments. Data include the hospital's internal documents (n = 10,536), implementation outcome indicators (n = 4), a survey among clinicians (n = 47), and interviews with individuals contributing to VBHC at the hospital level (n = 20). RESULTS The change towards VBHC is characterized by three sequential strategies. Initially, the focus was on deep change through local, tailored implementation of multiple VBHC elements. The strategy then transitioned to a hospital-wide program aimed at evolutionary change on a large scale, emphasizing the integration of VBHC into mainstream IT and policies. Recognizing the advantages and limitations of both strategies, the hospital currently adopts a "hybrid" strategy. This strategy delicately combines deep and broad change efforts. The strategy evolved based on accumulated insights, contextual developments and shifts in decision-makers. The complexity of change was downplayed in plans and stakeholder communication. By the end of 2023, 68 (sub)departments engaged in VBHC, enabled to discuss patients' responses to Patient Reported Outcomes Measures (PROMs) during outpatient care. However, clinicians' use of PROMs data showed limitations. While pioneers delved deeper into VBHC, laggards have yet to initiate it. CONCLUSIONS VBHC does not lend itself to linear planning and is not easily scalable. While there appears to be no golden standard for implementation, blending local and larger-scale actions appears advantageous. Local, deep yet harmonized and system-integrated changes culminate in large scale transformation. Embracing complexity and focusing on the ultimate aims of (re)institutionalization and (re)professionalization are crucial.
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Affiliation(s)
- Veerle van Engen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Martina Buljac-Samardzic
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Rob Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Kees Ahaus
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Ingrid Peters
- Department of Quality and Patient Care, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Igna Bonfrer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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van der Knaap-Kind LS, Ombashi S, Van Roey V, Kragt L, Peterson P, Jabbari F, Wolvius EB, Versnel SL. Evaluation and recommendations of the oral health, oral function, and orofacial aesthetics-related measures of the ICHOM Standard Set for Cleft Lip and Palate. Int J Oral Maxillofac Surg 2024; 53:563-570. [PMID: 38228465 DOI: 10.1016/j.ijom.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024]
Abstract
This study was performed to evaluate the efficacy of outcome measures for the orofacial domain included in the International Consortium for Health Outcomes Measurement Standard Set for Cleft Lip and Palate (ICHOM-SCS). In this multicentre study involving two cleft centres, suggestions to optimize the type and timing of outcome measures were made based on data and clinical experience. Patient-reported outcome measures (PROMs) (CLEFT-Q Jaw, Teeth, Eating/Drinking; Child Oral Health Impact Profile-Oral Symptoms Scale (COHIP-OSS)) and clinical outcome measures (caries experience and dental occlusion) data were collected retrospectively for age 5, 8, 10, 12, 19, and 22 years. The data were categorized by cleft type and analysed within and between age groups using Spearman correlation, the distribution of responses per item, a two-sample test for equality of proportions, and effect plots. Most correlations between PROMs and clinical outcome measures were weak (r < 0.5), suggesting PROMs and clinical outcome measures complement each other. The COHIP-OSS and CLEFT-Q Eating/Drinking barely detected problems in any patient category and are no longer recommended. A suitable alternative appears complex to find; outcomes of this study and the recent literature doubt an added value. Similar problems were found in the CLEFT-Q Jaw at time-point 12 years. Therefore, time-points 15 and 17 years are currently suggested.
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Affiliation(s)
- L S van der Knaap-Kind
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - S Ombashi
- Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose And Throat Disorders, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - V Van Roey
- Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose And Throat Disorders, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - L Kragt
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - P Peterson
- Department of Reconstructive Plastic Surgery, Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | - F Jabbari
- Department of Dental Medicine, Orthodontics and Paediatric Dentistry, Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose And Throat Disorders, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S L Versnel
- Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands; European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose And Throat Disorders, Erasmus University Medical Center, Rotterdam, the Netherlands
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Sarilita E, Sjamsudin E, Mossey PA. Scoping review of outcome measures in cleft care used in research and reports. Orthod Craniofac Res 2024; 27 Suppl 1:42-48. [PMID: 37767819 DOI: 10.1111/ocr.12711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 08/10/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
Treatment outcome measures are critical in the decision making of best practices in the OFC field. OFC consortium working groups provided standardization of outcome measures based on previous treatment outcome studies. However, the implementation of such standardization in OFC centres worldwide is unknown. This study presented mapped outcome measures in cleft care using a structured review method complemented by quantitative overview of the relevant published research to provide initial guidelines for the implementation of treatment outcome standardization. A scoping review of the literature of treatment outcomes in cleft care following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines was performed. The selected indexed paper in outcome measures mapped following the international consortium in standard set of outcome measures in cleft care. Three hundred and sixty-five articles were filtered. The most discussed domains of cleft care were dental and oral health, appearance and speech/communication. Overall, the majority of publications were produced in high-income countries. The current review indicates that there are inequalities of treatment outcome studies among the domain of cleft care. In addition, there are also inequalities of published articles from HIC versus LMIC in treatment outcomes. This information can be used to develop targeted interventions aimed at encouraging cleft centres worldwide to adapt standardized outcome measures.
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Affiliation(s)
- Erli Sarilita
- Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Endang Sjamsudin
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Peter A Mossey
- Division of Oral Health Sciences and WHO Collaborating Centre for Oral Health & Craniofacial Anomalies, University of Dundee, Dundee, Scotland, UK
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Apon I, van Leeuwen N, Polinder S, Versnel SL, Wolvius EB, Koudstaal MJ. Healthcare use and direct medical costs in a cleft lip and palate population: an analysis of observed and protocolized care and costs. Int J Oral Maxillofac Surg 2024; 53:286-292. [PMID: 37734991 DOI: 10.1016/j.ijom.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 07/26/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
This study was performed to describe observed healthcare utilization and medical costs for patients with a cleft, compare these costs to the expected costs based on the treatment protocol, and explore the additional costs of implementing the International Consortium for Health Outcomes Measurement (ICHOM) Standard Set for Cleft Lip and Palate (CL/P). Forty patients with unilateral CL/P between 0 and 24 years of age, treated between 2012 and 2019 at Erasmus University Medical Center, were included. Healthcare services (consultations, diagnostic and surgical procedures) were counted and costs were calculated. Expected costs based on the treatment protocol were calculated by multiplying healthcare products by the product prices. Correspondingly, the additional expected costs after implementing the ICHOM Standard Set (protocol + ICHOM) were calculated. Observed costs were compared with protocol costs, and the additional expected protocol + ICHOM costs were described. The total mean costs were highest in the first year after birth (€5596), mainly due to surgeries. The mean observed total costs (€40,859) for the complete treatment (0-24 years) were 1.6 times the expected protocol costs (€25,198) due to optional, non-protocolized procedures. Hospital admissions including surgery were the main cost drivers, accounting for 42% of observed costs and 70% of expected protocol costs. Implementing the ICHOM Standard Set increased protocol-based costs by 7%.
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Affiliation(s)
- I Apon
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - N van Leeuwen
- Medical Decision-Making Section, Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S Polinder
- Health Technology Assessment and Implementation Section, Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S L Versnel
- Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M J Koudstaal
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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Rausch-Koster TP, van der Aa HPA, Verbraak FD, van Rens GHMB, van Nispen RMA. Perspectives of Patients and Professionals on Implementing a Computer Adaptive Vision-Related Quality of Life Outcome (CAT-EyeQ) in Clinical Practice. Transl Vis Sci Technol 2024; 13:6. [PMID: 38470320 PMCID: PMC10941993 DOI: 10.1167/tvst.13.3.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/29/2024] [Indexed: 03/13/2024] Open
Abstract
Purpose The CAT-EyeQ is a computer adaptive test (CAT) which measures vision-related quality of life in patients having exudative retinal diseases. The aim of this study is to investigate the usability of the CAT-EyeQ in clinical practice and identify potential barriers and facilitators for implementation (problem analysis). Methods Patients and health care professionals participated in the study regarding the usability of the CAT-EyeQ, and clinic managers and health care professionals were included in the problem analysis for implementation. In total, we conducted 18 semi-structured interviews. The Consolidated Framework for Implementation Research (CFIR) was used to develop the interview guides and to structure results. Results Six themes were derived from the usability study and problem analysis: (1) quality of the CAT-EyeQ and the applicability to patients' needs and preferences, (2) embedding the CAT-EyeQ in current practice, (3) implementation climate of the eye hospitals, (4) attitude of professionals, (5) engaging and encouraging professionals, and (6) integration of the CAT-EyeQ in health care - needs after piloting. Conclusions Patients and professionals mentioned that the CAT-EyeQ improved insight into the impact of eye diseases on a patient's daily life, it allowed for more attention on the patient perspective and the structured measurement of vision-related quality of life. The main perceived barriers mentioned by professionals for using the CAT-EyeQ were lack of time and the integration of the patient-reported outcome measure (PROM) results within the electronic patient record (EPR). Translational Relevance The CAT-EyeQ, accompanied by an overview of stakeholder perspectives resulting from this implementation study, can now be used in clinical practice.
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Affiliation(s)
- T. P. Rausch-Koster
- Amsterdam UMC location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Aging and Later Life, Amsterdam, The Netherlands
- Bergman Clinics, Department of Ophthalmology, Naarden, The Netherlands
| | - H. P. A. van der Aa
- Amsterdam UMC location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Aging and Later Life, Amsterdam, The Netherlands
- Expertise Innovation Knowledge, Robert Coppes Foundation, Vught, The Netherlands
| | - F. D. Verbraak
- Amsterdam UMC location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Aging and Later Life, Amsterdam, The Netherlands
| | - G. H. M. B. van Rens
- Amsterdam UMC location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Aging and Later Life, Amsterdam, The Netherlands
| | - R. M. A. van Nispen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Ophthalmology, De Boelelaan, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Aging and Later Life, Amsterdam, The Netherlands
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Aycart MA, Caterson EJ. Advances in Cleft Lip and Palate Surgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1932. [PMID: 38003981 PMCID: PMC10672985 DOI: 10.3390/medicina59111932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023]
Abstract
Cleft lip with or without cleft palate is one of the most common congenital malformations, with an average prevalence of 1 in 1000 live births. Cleft lip and/or palate is incredibly phenotypically diverse, with constant advancements and refinements in how we care for patients. This article presents an in-depth review of the latest advances and current evidence in cleft lip and palate surgery. This includes presurgical infant orthopedics, perioperative practice patterns including use of enhanced recovery after surgery (ERAS) protocols, patient-reported outcome measures, and the latest adjuncts in cheiloplasty and palatoplasty.
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Affiliation(s)
- Mario A. Aycart
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Nemours Children’s Health-Delaware, 1600 Rockland Road, Wilmington, DE 19803, USA;
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Harrison CJ, Rodrigues JN, Furniss D, Swan MC. Response to Barriers and Facilitators to the International Implementation of Standardized Outcome Measures in Clinical Cleft Practice. Cleft Palate Craniofac J 2021; 59:669-670. [PMID: 33973480 PMCID: PMC9047092 DOI: 10.1177/10556656211015013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Conrad J Harrison
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Jeremy N Rodrigues
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.,Department of Plastic Surgery, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - Dominic Furniss
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - Marc C Swan
- Spires Cleft Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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