Why take on a Value Based Healthcare transformation approach?

• Elective hip replacement surgery pathway for primaryosteoarthritis is clearly defined across two sites, withpathway specific outcome measures.

• The aim is to understand the value (how well thispathway is doing) across the complete pathway of care.

• Patient reported outcomes measures (PROMS)mandated by the NHS (Oxford Hip Score, EQ-5D, EQ-VAS) were extracted with a focus on understanding,measuring and sharing outcomes that matter to patientsand carers. Ethics approval to use patient data was

attained.

• The cost of a service user moving through the hipreplacement pathway was calculated. This was used todevelop clinically-meaningful cost information fordelivering outcomes. This information will informchanges that can be made to the pathway to improveoutcomes, efficiency, and ensure better value.

Value Based Healthcare analysis of joint replacement surgery for primary hip osteoarthritisDr Lucinda Gabriel1, Darzi Fellow, Mr Joseph Casey1, Deputy Director Programme Delivery, Ms Claire Palmer2, Head of Patient Outcomes, Mr Matt Gee2, Orthopaedic Lead, Prof John Moxham1, Director Value Based Healthcare, Mr Joydeep Sinha2, Consultant Orthopaedic and Trauma Surgeon, Mr Toby Colgate-Stone2, Consultant Orthopaedic and Trauma Surgeon. 1King’s Health Partners 2King’s College Hospital. Correspondence: Lucinda.Gabriel@kcl.ac.uk.

Calculating value: understanding outcomes that matter to patients and carers and clinically-meaningful cost information

Results• Each pathway n=25; no significant difference between groups with

regard to age, sex, number of comorbidities

ConclusionUnderstanding the value of pathways of care, is inherently difficult. Howeveraccurate clinical costing is a patient-centred issue with the potential tochange the way healthcare is incentivised and funded in order to make itsustainable, equitable and effective. Accurate data capture is critical toachieving VBHC which has become an organisational priority and pathwaysof care are being modified to fit the higher value IPU model more closely.

Understand pathway of care by condition (rather than procedure)

VALUE = OUTCOMESCOSTS

• 100% survival and no significant differences in PROMS,

• Improvements in EQ-5D, EQ-VAS and OHS exceeded the national expected average

• Improvements were also noted when outcomes were rearranged

• Multiple quality reviews required to ensure costs were accurate however outliers persisted

• Model 1 was leaner with lower costs and a higher margin.

• Model 1 was the higher value pathway.

Traditional PROMS vs patient-centred outcomes

DiscussionThe higher value of pathway 1 likely arose from the standardised nature ofthe Integrated Practice Unit (IPU) model characterised by a single entrypoint. This hastens the patient journey reducing the ill effect of protractedwaits associated with clinical deterioration. This would reduce length of stayand is likely to aid recovery. Better communication amongst the multi-disciplinary team is a further advantage expediting diagnostic decisionmaking and treatment processes. These factors all contribute to a reductionin the costs incurred.

Who are we?• King’s Health Partners is an Academic Health Sciences Centre (AHSCs)

in South London. Based on breaking down barriers and increasingcooperation and focus, AHSCs seek to combine basic and translationalhealth research, clinical care and education to create world-leadingimprovements in healthcare. We serve a population of eight million acrossSouth London and south east England. Our goal is to delivertransformational health improvements that are patient-centred,population-based and sustainable.

• The Value Based Healthcare (VBHC) programme is focused onsupporting our partner organisations to deliver excellent and consistenthealth outcomes whilst protecting our stretched NHS resources.

• VBHC prioritises patient experience and improved health, teaches staffhow to identify best value and empowers them to deliver the bestpossible care to their patients resulting in improved work satisfaction.

• It also ensures that commissioners of care are getting the best resultsfor the money available.

-1.00

-0.80

-0.60

-0.40

-0.20

0.00

0.20

0.40

0.60

0.80

1.00

Change in response to PROMs questions before surgery and after surgery at 6 month follow-up (average and range, Model A + B)

Dis

com

fort

(q4,

EQ

5D)

Usu

al p

ain

(q1,

OH

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Pain

sta

ndin

g up

(q8,

OH

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Sudd

en s

ever

e pa

in (q

10, O

HS)

Nig

ht p

ain

(q12

, OH

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Mob

ility

(q1,

EQ

5D)

Self

-car

e (q

2, E

Q5D

)

Usu

al a

ctiv

ities

(q3,

EQ

5D)

Trou

ble

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hing

(q2,

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Trou

ble

tran

spor

t (q3

, OH

S)

Trou

ble

putt

ing

on s

ocks

(q4,

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Hou

seho

ld s

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ing

(q5,

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Wal

k be

fore

pai

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vere

(q6,

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Clim

b fli

ght o

f sta

irs

(q7,

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Lim

ping

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Pain

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ith u

sual

wor

k (q

11, O

HS)

Anx

iety

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(q5,

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Hea

lth S

cale

(EQ

VAS)

- 15,0 00

- 10,0 00

- 5,00 0

0

5, 000

10, 000

15, 000

20, 000

25, 000

£

Pathway total cost, total income to provider (i.e., tariff and) margin by patient for pathway (Model 1)

Tot al cost Tot al in come M ar gin

Excluded from analysis of cost information due to issues of data accuracy (n=4)

- 15,0 00

- 10,0 00

- 5,00 0

0

5, 000

10, 000

15, 000

20, 000

25, 000

£

Pathway total cost, total income to provider (i.e., tariff and) margin by patient for pathway (Model 2)

Tot al cost Tot al in come M ar gin

Excluded from analysis of cost information due to issues of data accuracty(n=11)