Call for tender for project: Aid for health research and development projects 2023: Promotion of health research activity

Funding body: Department of Health of the Basque Government

Record no.: 2023111085

PI: Borja García-Lorenzo

Funding awarded: €66.599,82.

Description:This project provides tools and methodological advances for the implementation and scalability of Value Based Care (VBC), such as the validation of questionnaires that measure patient experience (Patient Related Experience, PRE), and the estimation of a composite indicator for the numerator of the value equation of Porter et al. Value-Based Medicine (VBM) places patients at the centre of healthcare by including them in decision-making and actions to improve the healthcare system; it allows care to be personalised by being able to adjust treatments in relation to the specific response of patients; it allows best practices to be shared and, furthermore, it participates in the sustainability of the system by optimising processes.

To this end, the standardisation of Patient Centered Outcomes (PCO) and their accurate and systematic measurement is an essential requirement. These outcomes should include Patient Reported Outcomes (PRO), Patient Related Experience (PRE), Clinical Related Outcomes (CRO), and Care-Process Related Outcomes (CAPRO). This is why VBA also enables the design and improvement of health information systems to change the epistemological paradigm and thus the way in which decisions are made.

Objective:

• To construct the numerator of the value equation as a composite indicator of Patient-Centered Outcomes (PCO) defined as: Patient Reported Outcomes (PRO), Patient Related Experience (PRE), Clinical Related Outcomes (CRO), and Care-Process Related Outcomes (CAPRO). The aim of the project is to analyse the new models of access to PC, as well as the possible inequities and inequalities that may arise from this model, with a view to designing strategies to resolve them.
  • To assess the psychometric properties (validity and reliability) of the questionnaires to be used to measure the results of the patient experience (Patient Related Experience, PRE).
  • To assess the impact of Patient Reported Outcome (PRO) on the composite indicator of the numerator of the value equation.
  • Assess the impact of Clinical Related Outcomes (CRO) on the composite indicator in the numerator of the value equation.
  • Assess the impact of Care-Process Related Outcomes (CAPRO) on the composite indicator in the numerator of the value equation.
  • To assess the impact of Patient Related Experience (PRE) outcomes on the composite indicator of the numerator of the value equation.

Design: Longitudinal observational prospective cohort study in which patients diagnosed with breast cancer will be recruited and followed up at three stages of the care process:

o Diagnosis: consultation where the diagnosis is confirmed.
o Treatment: contact with the health centre where they start their first treatment.

Expected results: The numerator approach to the value equation should not only be useful in the context of breast cancer, but also in any other medical condition as a methodological tool. These advances in VBA will be useful to advance VBA by putting the patient at the centre, measuring and assessing outcomes, and using them to inform patient information, benchmarking between centres and patients to support professional decision-making in patient care, helping to identify and share best practices, and optimising evidence-based health service provision, redesigning care pathways, including the generation of new roles, redistribution of resources and elimination of redundant or low-value processes.

In addition, the existence of a robust evidence-based evaluative framework from VBA will guide health authorities in the design of mechanisms that encourage payment for value, abandoning the payment for activity that has historically governed health systems around the world. Being able to condition reimbursement for healthcare services on the value provided to patients is a way forward, and studies such as these provide useful tools that can help in rigorously measuring what is relevant and important to patients.