A multiple criteria framework for value-based assessment of health care services applied to a radiology case

Traditionally, value-based health care assessment initiatives have: (1) not explicitly evaluated value; (2) been complex (which limits reproducibility) and not admitted customization; and 4) not operationalized value in a way that addresses the concerns of the involved stakeholders. This research developed a four-step framework for value-based assessment of health care services that aims to overcome these limitations. The development of the framework was supported by a case study conducted in the radiology department of the second largest general hospital in Portugal and involved the participation of administrators, physicians, radiographers, and patients, and incorporates several Multiple Criteria Decision Analysis methods. A set of 160 indicators to assess the value of radiology departments was identified in the literature and synthesized into 7 value-assessment dimensions. The framework considers specific indicators for each stakeholder type and suggests customizable ways to determine the benefit of the service. Additionally, we determined the value of the radiology department (considering benefits perceived by stakeholders and direct clinical costs) and propose a dashboard to monitor its evolution. The developed management tool enables an explicit valuation of the department and uncovers service features that need to be improved. If its use is continued, it will report the evolution of the department. The framework can easily be adapted to other hospitals or departments or be used by researchers as a basis for the development of other models.