Measuring Patient Value after Total Shoulder Arthroplasty

Evaluating the value of health care is of paramount importance to keep improving patients’ quality of life and optimizing associated costs. Our objective was to present a calculation method based on Michael Porter’s formula and standard references to estimate patient value delivered by total shoulder arthroplasty (TSA). We retrospectively reviewed the records of 116 consecutive TSAs performed between June 2015 and June 2019. Patient value was defined as quality of care divided by direct costs of surgery. Quality metrics included intra- and postoperative complications as well as weighted improvements in three different patient-reported outcome measures at a minimum of one-year follow-up. Direct costs of surgery were retrieved from the management accounting analyses. Substantial clinical benefit (SCB) thresholds and the standard reimbursement system were used as references for quality and cost dimensions. A multivariable linear regression was performed to identify factors associated with patient delivered value. Compared to a reference of 1.0, the quality of care delivered to patients was 1.3 ± 0.3 (range, 0.6–2.0) and the associated direct cost was 1.0 ± 0.2 (range, 0.7–1.6). Ninety patients (78%) had a quality of care ≥1.0 and 61 patients (53%) had direct costs related to surgery ≤1.0. The average value delivered to patients was 1.3 ± 0.4 (range, 0.5–2.5) with 91 patients (78%) ≥ 1.0, was higher for non-smokers (beta, 0.12; p = 0.044), anatomic TSA (beta, 0.53; p < 0.001), increased with higher pre-operative pain (beta, 0.08; p < 0.001) and lower pre-operative Constant score (beta, −0.06; p = 0.001). Our results revealed that almost 80% of TSAs provided substantial patient value. Patient pre-operative pain/function, tobacco use, and procedure type are important factors associated with delivered patient value.

Changing the process of prescribing to procuring lymphoedema compression garments: a service evaluation

Compression garments are the mainstay of lymphoedema treatment, yet the process of obtaining by prescription is lengthy, governed by funding, involves numerous professionals with little patient value and often involes copious inaccuracies, delays and errors. This service evaluation estimates the potential impact of changing the way compression garments are accessed from a prescription to a procurement process. The main objective was to estimate the impact and costs of altering the process within the NHS Wales setting. A service evaluation was formally supported by Medicine Management and Lymphoedema Wales Strategy Board to compare the prescription process to a new procuring route. A form was devised so that data was could be collected over 12 months by lymphoedema therapists on each compression garment issued to patients attending two lymphoedema services in NHS Wales. The data collected included information on the garment ordered, costs (prescribed compared to procured), timing between garment ordered and received plus a comparison of the processes. All non-patient identifiable data was entered into a database and comparison analysis was completed to identify any correlations between the variables collected. The project was ratified by research and development as service evaluation. There was a total of 5392 completed patient data forms were included, which when compared to the processes indicated that using a prescription route is overwhelmingly more costly than procuring. Overall costs suggest the potential for substantial savings to NHS Wales (£71.10 per patient) were statistically significant (P<0.001). Potential for improved patient outcomes was observed as garments were provided directly on appointment instead of significant delays promoting value-based healthcare.

Mediating knowledge across health ecosystems: a qualitative field study

Purpose Knowledge sharing across health ecosystems is extremely fuzzy because of knowledge asymmetries, barriers and diverse types and sources of knowledge, all of which together affect patient decision making and value creation. The purpose of this study is to identify core knowledge mediators across ecosystem with the focus on a patient as a central decision maker in their own health management to ensure smooth knowledge flows across actors. Design/methodology/approach To understand the knowledge flows in the health ecosystem, a phenomenological approach was applied in this study. Based on case study research. The analysis is based on the patient-centric approach and draws on qualitative, semi-structured interviews. Moreover, a knowledge-creating community approach (Paavola et al., 2004) is applied in which various stakeholders create and share knowledge of clinical and social domain, which together contribute to patient value creation. Findings Knowledge socialization and development starts within very close and trusted community members. Trust, validity, reliability and responsibility of knowledge have emerged as full mediators for knowledge absorption. Thus, health communities and knowledge ecosystems need safe places for “unverified” knowledge to ensure that the important trends and unresolved questions are not missed. Originality/value This study proposes a new health knowledge management approach for communities, which is more than clinical decisions and formal medical knowledge and embraces varieties of knowledge and information sources and types. At the end, the identified barriers and mediators can be used for serving the main goal of patient value increase because it responds to the need for a systematic approach in encouraging patients to play a more active role in their own health management.