European value-based healthcare benchmarking: moving from theory to practice

Abstract

Background: Value-based healthcare (VBHC) is a conceptual framework to improve the value of healthcare by health, care-process and economic outcomes. Benchmarking should provide useful information to identify best practices and therefore a good instrument to improve quality across healthcare organizations. This paper aims to provide a proof-of-concept of the feasibility of an international VBHC benchmarking in breast cancer, with the ultimate aim of being used to share best practices with a data-driven approach among healthcare organizations from different health systems.

Methods: In the VOICE community-a European healthcare centre cluster intending to address VBHC from theory to practice-information on patient-reported, clinical-related, care-process-related and economic-related outcomes were collected. Patient archetypes were identified using clustering techniques and an indicator set following a modified Delphi was defined. Benchmarking was performed using regression models controlling for patient archetypes and socio-demographic characteristics.

Results: Six hundred and ninety patients from six healthcare centres were included. A set of 50 health, care-process and economic indicators was distilled for benchmarking. Statistically significant differences across sites have been found in most health outcomes, half of the care-process indicators, and all economic indicators, allowing for identifying the best and worst performers.

Conclusions: To the best of our knowledge, this is the first international experience providing evidence to be used with VBHC benchmarking intention. Differences in indicators across healthcare centres should be used to identify best practices and improve healthcare quality following further research. Applied methods might help to move forward with VBHC benchmarking in other medical conditions.

Figure 1

Benchmarking of health outcomes indicators.^a IRR, incidence rate ratio; OR, odds ratio ^aSite A is the reference site. Single operation rate for invasive cancer, single operation rate for DCIS, appropriate chemotherapy rate and appropriate time to surgery/treatment are care-process indicators (CAPROs); Specialist visits, Diagnostic tests, hospital length of stay, patient rate undergoing major outpatient surgery, day hospital sessions, patient treated with new therapies under chemotherapy are economic indicators (EROs). ^bNo economic information available from site E. ^cSince no variability in outcome values was observed, Site E is omitted. ^dSince no variability in outcome values was observed, Site F is omitted. ^eSince no variability in outcome values was observed, Site C is omitted.

Figure 2

Benchmarking of care-process and economic indicators.^a,b IRR, incidence rate ratio; OR, odds ratio ^aSite A is the reference site. Single operation rate for invasive cancer, single operation rate for DCIS, appropriate chemotherapy rate and appropriate time to surgery/treatment are care-process indicators (CAPROs); Specialist visits, Diagnostic tests, hospital length of stay, patient rate undergoing major outpatient surgery, day hospital sessions, patient treated with new therapies under chemotherapy are economic indicators (EROs). ^bNo economic information available from site E. ^cSince no variability in outcome values was observed, Site E is omitted. ^dSince no variability in outcome values was observed, Site F is omitted. ^eSince no variability in outcome values was observed, Site C is omitted.