Experiences and learnings from developing and implementing a co-designed value-based healthcare framework within Victorian public oral health sector.

Objective This study aimed to describe the development and implementation of a co-designed value-based healthcare (VBHC) framework within the public dental sector in Victoria. Methods A mixed-method study was employed. Explorative qualitative design was used to examine patient, workforce and stakeholder perspectives of implementing VBHC. Participatory action research was used to bring together qualitative narrative-based research and service design methods. An experience-based co-design approach was used to enable staff and patients to co-design services. Quantitative data was sourced from Titanium (online patient management system). Results Building a case for VBHC implementation required intensive work. It included co-designing, collaborating, planning and designing services based on patient needs. Evidence reviews, value-stream mapping and development of patient reported outcomes (PROMs) and patient reported experience measures (PREMs) were fundamental to VBHC implementation. Following VBHC implementation, a 44% lower failure to attend rate and 60% increase in preventive interventions was reported. A higher proportion of clinicians worked across their top scope of practice within a multi-disciplinary team. Approximately 80% of services previously provided by dentists were shifted to oral health therapists and dental assistants, thereby releasing the capacity of dentists to undertake complex treatments. Patients completed baseline International Consortium for Health Outcomes Measurement PROMs (n = 44,408), which have been used for social/clinical triaging, determining urgency of care based on risk, segmentation and tracking health outcomes. Following their care, patients completed a PREMs questionnaire (n = 15,402). Patients agreed or strongly agreed that: the care they received met their needs (87%); they received clear answers to their questions (93%); they left their visit knowing what is next (91%); they felt taken care of during their visit (94%); and they felt involved in their treatment and care (94%). Conclusion The potential for health system transformation through implementation of VBHC is significant, however, its implementation needs to extend beyond organisational approaches and focus on sustaining the principles of VBHC across healthcare systems, policy and practice.

Hürthle cell neoplasms diagnosed by fine needle aspiration are not associated with an increased risk of malignancy.

OBJECTIVES: The aim of this study is to determine the risk of neoplasm and malignancy in thyroid fine needle aspiration (FNA) diagnosed as atypia of undetermined significance with Hürthle cell change (AUS-H) or Hürthle cell neoplasm (HCN). STUDY DESIGN: A computerized search of our laboratory information system was performed to identify all thyroid FNA and correlating surgical pathology diagnoses including Hürthle cell or oncocyte in the diagnostic nomenclature. The risks of neoplasm and malignancy were calculated for AUS-H and HCN categories separately. RESULTS: For the 29 AUS-H cases, the follow-up histology demonstrated 15 benign lesions, 4 follicular adenomas, 7 Hürthle cell adenomas, 1 papillary microcarcinoma (PMC), 1 follicular carcinoma and 1 Hürthle cell carcinoma. For the 93 HCN cases, the follow-up histology demonstrated 28 benign lesions, 9 follicular adenomas, 32 Hürthle cell adenomas, 2 PMCs, 2 papillary thyroid carcinomas, 6 follicular carcinomas and 14 Hürthle cell carcinomas. CONCLUSIONS: The risks of neoplasm and malignancy were 62 and 7% for the AUS-H category and 73 and 24% for the HCN category, respectively. The risk of malignancy for the AUS-H patients is within the 5- to 15-percent range suggested by the Bethesda System for Reporting Thyroid Cytology and within the 15- to 30-percent range suggested for follicular neoplasms.