Egidio de Mattia

Background/Objectives: A successful implementation of VBHC requires significant transformations, spanning from structural adjustments to a fundamental shift in organizational culture. However, organizations often adopt VBHC principles piecemeal, while managers overlook diverse staff reactions and their leadership role. To address these challenges, we developed and validated a multi-source assessment tool for use by organizations during their transition to VBHC to determine whether they are progressing effectively in both the dimensions. Method: To develop the first version of the tool, a multidisciplinary group translated strategies identified in a previous scoping review into questionnaire items through structured sessions. To validate it, a two round Delphi analysis was conducted. Experts in VBHC, management, health economy and clinical/researcher were contacted to ask for their participation. Consensus was established based on the following criteria: a median (Mdn) score of ≥4, an interquartile range (IQR) of ≤1.5 or ≤2, and a frequency of ratings in the range [4–5] ≥ 70%. Results: A total of 54 experts were invited to participate in the Delphi survey. The first round received 25 responses, while the second round had 23 responses. The final version of the assessment tool consists of 30 questions divided into two macro-areas: the Value Agenda Section and the Change Management Section. All items achieved a minimum frequency of ratings > 80% during both the rounds. Conclusion: By comparing the perspectives of managers and clinicians, the resulting tool enables organizations to assess the adoption of the Value Agenda component, as well as the change management strategies supporting its implementation.

Background/Objectives: The principles of value-based healthcare (VBHC) have received widespread endorsement, leading healthcare organizations worldwide to shift their strategies towards them. However, despite growing recognition and acceptance, the actual implementation of value-based approaches varies widely. This research aims to identify studies that address the implementation of VBHC at different levels (healthcare policymakers, hospital administrators, and healthcare providers), focusing on each level’s relative strategies. Methods: To this end, a scoping review was conducted in accordance with the PRISMA extension for the scoping reviews checklist. The electronic databases of Web of Science, PubMed, MEDLINE, and Scopus were searched to identify relevant publications in English from January 2006 to 31 July 2023. Results: We identified 30 eligible studies. Findings are organized into four main macro strategic levels, each comprising specific dimensions and operational approaches. Fourteen articles analyzed the role of government commitment in VBHC implementation, while six articles focused on regional integrated care systems. The role of hospitals was described in sixteen records. Conclusions: Our study suggests that a comprehensive approach is necessary for the successful implementation of VBHC. Hospitals emerge as pivotal in this shift, requiring organizational and attitudinal changes among healthcare professionals. However, a complete transition towards VBHC that ensures seamless patient management throughout the entire care delivery value chain necessitates government involvement in terms of state legislation, reimbursement methods, and hospital networking.

Background/Objectives: The principles of value-based Healthcare (VBHC) have received widespread endorsement, lead-ing healthcare organizations worldwide to shift their strategies towards them. However, despite growing recognition and acceptance, the actual implementation of value-based approaches varies widely. This research aims to identify studies that address the implementation of VBHC at dif-ferent levels (healthcare policymakers, hospital administrators, and healthcare providers), fo-cusing on each level’s relative strategies; Methods: To this end, a scoping review was conducted in accordance with the PRISMA extension for Scoping Reviews checklist. The electronic databases of Web of Science, PubMed, MEDLINE and Scopus were searched to identify relevant publica-tions in English from January 2006 to 31 July 2023; Results: We identified 30 eligible studies. Findings are organized into four main macro strategic levels, each comprising specific dimen-sions and operational approaches. Fourteen articles analyzed the role of government commitment in VBHC implementation, while six articles focused on regional integrated care systems. The role of hospitals was described in sixteen records; Conclusions: Our study suggests that a compre-hensive approach is necessary for the successful implementation of VBHC. Hospitals emerge as pivotal in this shift, requiring organizational and attitudinal changes among healthcare profes-sionals. However, a complete transition towards VBHC that ensures a seamless patient manage-ment throughout the entire care delivery value chain, necessitates government involvement in terms of state legislation, reimbursement methods, and hospital networking.

Within the EASY-NET network program (NET-2016-02364191), Work Package 1 Lazio evaluates the effectiveness of a structured audit and feedback (A&F) intervention compared with the web-based regional periodic publication of indicators in improving the appropriateness and timeliness of emergency healthcare for acute myocardial infarction (AMI). This work describes the A&F methodology and presents the results of the first feedback delivered. The intervention involves sending periodic reports via e-mail to participating hospitals. The feedback reports include a set of volume and quality (process and outcome) indicators, calculated by facility through the health information system of the Lazio Region and compared with regional mean, target values and values calculated for hospitals with similar volumes of activity. Health managers and clinicians of each participating hospital represent the “feedback recipients”. They are invited to organize clinical and organizational audit meetings to identify possible critical issues in the care pathway and define, where necessary, improvement actions. A total of 16 facilities are involved. Twelve facilities present high volumes in all volume indicators, while three facilities present low volumes for each indicator. Concerning the quality indicators, four facilities do not present critical indicators or had average results, three facilities do not present critical indicators but show average results in at least one of the indicators and six facilities present a critical value for at least one of the indicators. The first report highlighted some critical issues in some facilities on several indicators. During the audit meetings, each facility analyzes these issues, defining appropriate improvement actions. The outcome of these actions will be monitored through subsequent reporting to support the continuous care quality improvement process.

Audit and Feedback (A&F) is an effective multidimensional strategy for improving the quality of care. The optimal methods for its implementation remain unclear. This study aimed to map the state of art of A&F strategies in the hospitals involved in a time-dependent emergency network. For these purposes, a structured questionnaire was defined and discussed within the research group. This consists of 29 questions in three sections: (1) characteristics of the structure, (2) internal feedback systems, and (3) external feedback systems. All structures involved in the network were invited to participate in the e-survey by indicating a Health Management representative and a clinical representative for the Cardiovascular (CaV) and/or for the Cerebrovascular area (CeV). Of 20 structures invited, a total of 13 (65%) responded to the survey, 11 for the CaV area and 8 for the CeV area. A total of 10 of 11 (91%) facilities for the CaV area and 8/11 (75%) for the CeV area reported that they perform A&F activities. All facilities perform at least one of the activities defined as “assimilating A&F procedures.” The most frequent is the presentation and discussion of clinical cases (82% CaV and 88% CeV) and the least is the identification of responsible for improvement actions (45% CaV and 38% CeV). In 4/10 (40%) facilities for the CaV area and 4/8 (50%) for the CEV area, corrective actions are suggested or planned when the feedback is returned. These results confirm the need to define, in a synergistic way with the relevant stakeholders, an effective and agreed A&F intervention to improve the level of implementation of A&F strategies.

Background and Aims: In oncology, there is increasing talk of personalized treatment and shared decision‐making (SDM), especially when multiple treatment options are available with different outcomes depending on patient preference. The present study aimed to define the set of main dimensions and relative tools to assess the Value brought to patients from a Breast Cancer's Clinical pathway structured according to a dynamic SDM framework.Methods: Starting from our previous systematic review of the literature, a deep search of the main evidence‐based and already validated questionnaires was carried out. In the second phase, to corroborate this grid, a Delphi survey was conducted to assess each questionnaire identified for each dimension, against the following seven value‐based criteria: Clinical Benefit, Safety, Care Team Well Being, Patient Reported Outcomes Measures, Green Oncology, Impact on Health Budget, and Genomic Profile.Results: The resulting 7‐dimension questionnaire is composed of 72 questions. Of these, some quantitatively and objectively assess the evolution of the patient's disease state, whereas others aim to ask patients about their active involvement in decisions affecting them and to investigate whether they were free to explore their preferences. Furthermore, to frame the analyzed phenomenon at the right time, for each questionnaire section, the specific, evidence‐based timing of administration is indicated.Conclusion: The resulting questionnaire is validated in its entirety and it is composed of a set of questions and relative time point for data collections to assess the Value brought to patients undertaking a Breast Cancer's Clinical pathway, structured according to a dynamic SDM framework. It constitutes a quantitative instrument to integrate patient centeredness with a personalized perspective in the care management of women with breast cancer.