Doctoral research TU/e: putting the patient at the heart of cardiovascular care
How Value-Based Healthcare helps reduce mortality rate and the number of complications among heart patients
Treatment results for patients at the Catherina Heart Center in Eindhoven have improved considerably thanks to a new approach in quality management. This is the conclusion of PhD researcher Dennis van Veghel, care manager at Catharina Hospital and director of the Dutch Heart Registration. Van Veghel used the principles of Value-Based Healthcare, which put the value for patients at the heart of healthcare. His results show that measuring and evaluating the results for patients closely and using them as a guide for better care, leads to significant improvements in outcomes for patients. Van Veghel will defend his PhD thesis on August 29th at the department of Biomedical Engineering of TU/e.
As in many other countries, hospitals in the Netherlands focus primarily on volume and costs, due to the funding agreements they have made with health insurers. As a consequence there is less attention for treatment effects that matter most to patients, such as complications and re-interventions.
In contrast, Value-Based Healthcare (VBHC) puts the outcome for patients at the heart of healthcare. "The core strenght of VHBC is that all involved parties focus on what is essential in care: what health gains are there for the patient, and at what cost? We call this the patient value ratio. An important parameter in this is quality of life", explains Van Veghel.
Applying these principles at the Catherina Heart Center resulted in, among other things, more attention for pre-operative care, more multidisciplinary collaboration and the introduction of additional checklists, for instance in the operating room.
This new approach not only reduced mortality rates among patients, they also suffered less complications, and they needed fewer repeat interventions. The mortality rate dropped from 2.3 to 1.0 per cent within 120 days after a bypass intervention, and from 3.1 to 2.0 per cent within one year. The rate of reinterventions decreased from 5.0 to 3.2 per cent. Every year approximately 1000 patients undergo a bypass procedure at the Catharina Hospital.
And this is not only good news for the patient. It is also the hospital and the health insurers who benefit, as complications and reinterventions tend to be costly.
According to Van Veghel, to get this practice really off the ground, it is essential that healtcare providers and insurers put the outcome for patients at the center of the agreements they make with one another. He has drawn up a number of new models that help all parties involved to focus on what is important for the patient.
In the current system, hospitals tend to get less funding if they are succesful in reducing the number of reinterventions. They are also no real incentive to improve the care in the whole chain of care.
The researcher proposes an alternative model, which makes the hospital performing the bypass responsible for the long term results, even after the patient has left their care. This encourages hospitals to seek quality improvements with doctors who take over from them in the recovery phase. Especially in complex interventions like bypasses, patients often spend only a limited time in the center that performs the surgery. Aftercare is usually provided in a hospital closer to the patient’s home.
VBHC holds much promise, says Van Veghel, since the methodology can act as a guide for policy decisions, for instance in determining the value of technological innovations at an early stage. He also sees an increasing role in VBHC for Artificial Intelligence, because it can provide much smarter data analysis.