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Value-Based Health Care for Chronic Care: Aligning Outcomes Measurement with the Patient Perspective
David Ebbevi1, Helena Hvitfeldt Forsberg, Anna Essén
1Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Solna, Stockholm, Sweden (Drs Ebbevi, Forsberg, and Ernestam); and Center for Human Resource Management and Knowledge Work, Stockholm School of Economics, Stockholm, Sweden (Dr Essén).
Background:
Value-based health care is increasingly used for developing health care services by relating patient outcomes to costs. A hierarchical value scorecard for creating outcome measurements has been suggested: the 3-tier model. The objective of this study was to test the model against the patient's view of value in a chronic care setting.
Methods:
Semistructured interviews with 22 persons with rheumatoid arthritis were conducted, transcribed, and analyzed using qualitative content analysis. Themes were extracted, and the model was critically applied and revised.
Results:
The study validates existing dimensions in the model but suggests adding information, social health, predictability, and continuity to make it more useful and representative of patients' preferences.
Conclusion:
Although the model aims to focus on outcomes relevant to patients, it lacks dimensions important to individuals with rheumatoid arthritis. The data illustrate difficulties in finding patients' preferred outcomes and imply tactics for arriving at meaningful measurements.
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