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
Objetivos: Comparar la tasa de cesáreas tras aplicar la medicina basada en la evidencia en el parto.Sujetos y métodos: Se incluyen todos los partos asistidos en nuestro hospital entre 2002 y 2007. Se establecen dos períodos, 2002-2004 y 2005-2007, considerando que nuestra práctica obstétrica se modificó en 2005.Resultados: Se asistieron 13.105 partos en el período 2002-2004 y 13.341 entre 2005 y 2007. En este período hubo una disminución significativa en las indicaciones por distocia (el 6,24 frente al 3,37%; p < 0,0001), riesgo de pérdida de bienestar fetal (el 4,35 frente al 3,14%; p < 0,0001), presentación de nalgas (el 4,48 frente al 3,7%;p = 0,04), cesárea anterior (el 1,2 frente al 0,4%;p < 0,0001) y tasa global de cesáreas (el 17,5 frente al 12,2%; p < 0,0001). No hubo diferencias en la mortalidad perinatal (el 6,62 frente al 7,1;p = 0,462), pH < 7 de arteria umbilical (el 3,1 frente al 4,0; p = 0,276), puntuación en la prueba de Apgar < 7 a los 5 min (el 1,8 frente al 1,8%; p = 0,743), ni ingresos en neonatología(el 2,95 frente al 3,0%; p = 0,87).Conclusión: La aplicación de la medicina basada en la evidencia reduce significativamente la tasa de cesáreas sin modificar los resultados perinatales (AU)
Objective: To compare cesarean rate in two different periods after introducing evidence based medicine in delivery.Subjects and methods: We include all the deliveries attended in our hospital between 2002 and 2007. We establish two different periods: 2002-2004 and 2005-2007 considering that our obstetric practice changed in 2005.Results: 13.105 births were attended in 2002-2004 and 13.341 in 2005-2007. In this period there was a significant reduction in indications for dystocia (6.24% vs 3.37%; P<.0001), nonreassuring fetal status (4.35% vs 3.14%; P<.0001), breech presentation (4,48 vs 3,7%; P=.04), previous cesarean (1,2% vs 0,4%; P<.0001), and overall cesarean rate (17.5 vs 12.2%; P<.0001). There were no differences in perinatal mortality(6,62 vs 7,1; P=.462), umbilical artery pH < 7 (3,1 vs 4,0; P=.276), 5 minutes Apgar test < 7 (1,8 vs 1,8; P=.743), or neonatal intensive care admission (2,95% vs 3,0%; P=.87). Conclusions: Applying an evidence based medicine model significantly reduces cesarean rate and does not affect perinatal outcomes (AU)