Health care should be driven by a constant focus on delivering outcomes that truly matter to patients. However, a lack of clarity regarding the definition of value has led to different approaches and slow progress. Some use the term ‘value’ to convey the humanistic tenets underpinning health systems, while others employ the term to refer to cost reduction and overall process efficiency.
The reality is that value-based healthcare has not yet been embraced as part of the everyday language and business of the NHS in the way that evidence-based healthcare has. Today we want to talk about value in sedation practice.
Why talk about Value Based Healthcare?
The World Health Organization (WHO) and the OECD both estimate that around 30% of resources spent on health care are wasted on avoidable complications, unnecessary treatments or administrative inefficiencies (Source: EIT Health, Implementing Value-Based Health care in Europe Handbook for Pioneers).
The relationship between the resources used and outcomes achieved in healthcare is under greater scrutiny. Resources are increasingly outstripped by demand for healthcare, driven by changing population demographics, innovation and new technologies, patient expectations and an increase in multi-morbidity. Adding to this pressure to meet ever-increasing demands, the NHS is underfunded and overstretched. Yet, evidence suggested that resources are all too often wasted (Source: Defining Value-based Healthcare in the NHS: CEBM report, University of Oxford).
What is Value Based Healthcare?
The first definition of value in health care was: outcomes that matter to patients divided by the cost to achieve these outcomes. This definition was introduced by Michael Porter and Elizabeth Teisberg in their book Redefining Health Care – a work that launched the entire field of Value-Based Health Care (2006).
In this value ratio, the numerator (outcomes) designates condition-specific results that matter most to patients, such as functional recovery and quality of life, while the denominator (cost) applies to the total spending for the full cycle of care.
Accordingly, if outcomes that matter to patients are not improved, the resulting value is low. This definition applies to the entirety of the care pathway, from primary to secondary and tertiary care, including post-hospital care for patients affected by a single or multiple conditions.
The only way to evaluate the true value of care is to measure patient health gains according to what they consider most important in their daily life. Measuring results of a treatment from the patient perspective is essential to improve its value.
But in different contexts, Value Based Healthcare can have different meanings.
For example, at Defining Value-based Healthcare in the NHS: CEBM report, University of Oxford (2019), it is defined as:
Value-based healthcare is the equitable, sustainable and transparent use of the available resources to achieve better outcomes and experiences for every person.
What does this mean for Sedation Practice?
When it comes to sedation, we need to think about what outcomes matter to patients, how to measure these and how to improve current practices towards a better standard.
Some outcomes that may be important to patients include:
- Analgesia throughout the procedure
- Comfort throughout the procedure
- No respiratory compromise
- No morbidity
- No mortality
We can also start thinking about the value of sedation as part of the whole patient journey. As it allows clinicians to perform more complex procedures, without general anaesthesia, or the fact that procedures have a faster onset and recovery. It can also be viewed from an economical standpoint, where there procedures are less invasive, the physiological impact is reduced and hospital stay is reduced.
As care delivery models evolve, it is natural that Value Based Healthcare will become more present in every day conversations in healthcare. And it is natural that sedation as a way to bring value and meet outcomes that matter to patients will be part of it.