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Original research
Developing process measures in value-based healthcare: the case of aortic valve disease
  1. Berdel Akmaz1,2,
  2. Nina Zipfel1,3,
  3. Roland A Bal2,
  4. Benno J W M Rensing4,
  5. Edgar J Daeter5,
  6. Paul B van der Nat1,3
  1. 1Department of Value-Based Healthcare, Sint Antonius Hospital, Nieuwegein, The Netherlands
  2. 2Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
  3. 3Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
  4. 4Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
  5. 5Department of Cardiothoracic Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
  1. Correspondence to Ms Berdel Akmaz; b.akmaz{at}outlook.com

Abstract

Background As process measures can be means to change practices, this article presents process measures that impact on outcome measures for surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) within value-based healthcare.

Methods Desk research and observations of patient trajectories were performed to map the processes involved in TAVR and SAVR. Semistructured interviews were conducted with healthcare professionals (n=8) and patients (n=2) to explore which processes were most important in relation to a standard set of outcome measures that was already monitored. Additionally, open interviews (n=2) were held to prioritise results. A focus group was performed for validation of the formulated process measures. Numerical data for these measures was not collected.

Results Process maps of the full cycle of care of TAVR and SAVR treatments in theory and in practice were developed. 28 processes were found important by interview participants due to their expected impact on patient-relevant outcomes. Seven processes were prioritised to be most important and were formulated into 12 process measures for both TAVR and SAVR: ‘Number of times that deficient information provision to SAVR patients causes negative outcomes’, ‘Type of TAVR/SAVR prosthesis’, ‘Brand of TAVR prosthesis’, ‘Number of times the frailty score of a TAVR/SAVR patient >75 years is measured’, ‘Time between TAVR/SAVR surgery indication and surgery’, ‘Number of times that anticoagulants are stopped within 3 days before surgery’, ‘Time in hours between TAVR/SAVR surgery and permanent pacemaker implantation’ and ‘Percentage of standardised pain measurements’.

Conclusion This study proposes an addition of select process measures to standard sets of outcome measures to improve healthcare quality. It illustrates a clear method for identifying process measures with impact on health outcomes in the future.

  • value-based healthcare
  • aortic valve disease
  • surgical aortic valve replacement
  • transcatheter aortic valve replacement
  • process measures

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjoq-2019-000716

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    Footnotes

    • Twitter @ninazipfel

    • Correction notice This article has been corrected since it was published. The license information has been updated.

    • Contributors BA, NZ, PBvdN and RAB designed the study. BA conducted data collection. BJWMR and EJD contributed to the participant sampling. BA and NZ analysed and interpreted the data. PBvdN and RAB critically revised data interpretation. BA drafted the manuscript with support of NZ. PBvdN, RAB, BJWMR and EJD revised the manuscript. All authors read and approved the final manuscript.

    • Funding This work was supported by The Netherlands Organisation for Health Research and Development (ZonMw) under project number 842001005. The funder had no influence on the study design, collection, analysis and interpretation of the data, the writing of the report, and the decision in where to submit the article for publication.

    • Competing interests None declared.

    • Patient consent for publication Verbal and written consent to participate was asked from all interviewed participants and data has been stored to ensure privacy. All participants consented to the publication.

    • Ethics approval A non-medical scientific research declaration was obtained from the Medical Research Ethics Committees United (MEC-U) of the St. Antonius Hospital with the following reference number: W15.006.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.