A public health value-based healthcare paradigm for HIV

BMC Health Services Research

Steven Callens¹  Eric Florence²  Peter Messiaen³  Nathalie Ausselet⁴  Jean-Cyr Yombi⁵  Eric Van Wijngaerden⁶  Paul De Munter⁶  Stefaan J. Vandecasteele⁷  Lieven Annemans⁸  Stéphane De Wit⁹  Agnès Libois⁹  Françoise Uurlings^1,10  Jean-Christophe Goffard^1,11  Sophie Henrard^1,11  Patrick Lacor^1,12  Lucie Seyler^1,12  Rémy P. Demeester^1,13  Sebastian Vermeersch^1,14 

[1] Department General Internal Medicine, Ghent University Hospital, Ghent, Belgium;Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium;Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium;Department of Infectious Diseases, CHU UCL Namur, Namur, Belgium;Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint Luc, Brussels, Belgium;Department of Microbiology Immunology, Transplantation and HIV Reference Centre, University Hospital Leuven, Leuven, Belgium;Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge Oostende AV, Brugge, Belgium;Department of Public Health, Ghent University, Ghent, Belgium;Division of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium;HIV Reference Centre, Infectious Diseases Department, Liège University Hospital, Liege, Belgium;HIV Reference Centre, Internal Medicine, C.U.B. Erasme, Université Libre de Bruxelles, Brussels, Belgium;HIV Reference Centre, Universitair Ziekenhuis Brussel, Brussels, Belgium;HIV Reference Centre, University Hospital of Charleroi, Charleroi, Belgium;Hict, Ottergemsesteenweg-Zuid 808 B/354, 9000, Gent, Belgium;

关键词: Value-based healthcare;    HIV;    Public health;    Indicators;    Frameworks;   

DOI  :  10.1186/s12913-021-07371-7

来源: Springer

【 摘 要 】

BackgroundHIV patients face considerable acute and chronic healthcare needs and battling the HIV epidemic remains of the utmost importance. By focusing on health outcomes in relation to the cost of care, value-based healthcare (VBHC) proposes a strategy to optimize quality of care and cost-efficiency. Its implementation may provide an answer to the increasing pressure to optimize spending in healthcare while improving patient outcomes. This paper describes a pragmatic value-based healthcare framework for HIV care.MethodsA value-based HIV healthcare framework was developed during a series of roundtable discussions bringing together 16 clinical stakeholder representatives from the Belgian HIV reference centers and 2 VBHC specialists. Each round of discussions was focused on a central question translating a concept or idea to the next level of practical implementation: 1) how can VBHC principles be translated into value-based HIV care drivers; 2) how can these value-based HIV care divers be translated into value-based care objectives and activities; and 3) how can value-based HIV care objectives and activities be translated into value-based care indicators. Value drivers were linked to concrete objectives and activities using a logical framework approach. Finally, specific, measurable, and acceptable structure, process and outcomes indicators were defined to complement the framework.ResultsOur framework identifies 4 core value areas where HIV care would benefit most from improvements: Prevention, improvement of the cascade of care, providing patient-centered HIV care and sustaining a state-of-the-art HIV disease management context. These 4 core value areas were translated into 12 actionable core value objectives. For each objective, example activities were proposed. Indicators are suggested for each level of the framework (outcome indicators for value areas and objectives, process indicators for suggested activities).ConclusionsThis framework approach outlines how to define a patient- and public health centered value-based HIV care paradigm. It proposes how to translate core value drivers to practical objectives and activities and suggests defining indicators that can be used to track and improve the framework’s implementation in practice.

【 授权许可】

CC BY