RESUMO
BACKGROUND: Value-based healthcare (VBHC) is a conceptual framework to improve the value of healthcare by health, care-process and economic outcomes. Benchmarking should provide useful information to identify best practices and therefore a good instrument to improve quality across healthcare organizations. This paper aims to provide a proof-of-concept of the feasibility of an international VBHC benchmarking in breast cancer, with the ultimate aim of being used to share best practices with a data-driven approach among healthcare organizations from different health systems. METHODS: In the VOICE community-a European healthcare centre cluster intending to address VBHC from theory to practice-information on patient-reported, clinical-related, care-process-related and economic-related outcomes were collected. Patient archetypes were identified using clustering techniques and an indicator set following a modified Delphi was defined. Benchmarking was performed using regression models controlling for patient archetypes and socio-demographic characteristics. RESULTS: Six hundred and ninety patients from six healthcare centres were included. A set of 50 health, care-process and economic indicators was distilled for benchmarking. Statistically significant differences across sites have been found in most health outcomes, half of the care-process indicators, and all economic indicators, allowing for identifying the best and worst performers. CONCLUSIONS: To the best of our knowledge, this is the first international experience providing evidence to be used with VBHC benchmarking intention. Differences in indicators across healthcare centres should be used to identify best practices and improve healthcare quality following further research. Applied methods might help to move forward with VBHC benchmarking in other medical conditions.
Assuntos
Benchmarking , Qualidade da Assistência à Saúde , Humanos , Benchmarking/métodos , Atenção à SaúdeRESUMO
Las metástasis en mama desde tumores primarios extramamarios suponen el 2% de todos los tumores malignos de la mama (linfomas y melanomas malignos son los más frecuentes), y pueden simular tumores primarios tanto clínica como radiológicamente. El pronóstico de pacientes con metástasis de mama de tumores sólidos en general es malo (el 80% mueren antes de un año). El tratamiento más aceptado es la escisión simple, por lo que conocer, previamente a la cirugía, la procedencia metastásica del nódulo impedirá una cirugía demasiado agresiva que no va a mejorar el pronóstico. Presentamos un caso de metástasis de mama de un melanoma maligno cutáneo diagnosticado en piel de costado derecho (extirpado 3 años antes) (AU)
Breast metastases from extramammary primary tumors account for 2% of all malignant breast tumors (the most common being lymphoma and malignant melanoma) and can mimic primary breast carcinoma clinically and radiologically. The prognosis of patients with metastases to the breast from solid tumors is generally poor, with 80% dying in the first year. The most widely accepted treatment is simple excision. Consequently, determining the source of metastases prior to surgery avoids further surgical procedures that will not improve prognosis. We present a case of metastases from malignant cutaneous melanoma to the breast diagnosed in the right thoracic wall and surgically excised 3 years previously (AU)
