Paper: "Defining Health in the Era of Value-based Care ..." mapped to Hodges' model

individual

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INTERPERSONAL : SCIENCES

humanistic --------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group

Q. What is value? Demand (Individual) freedom to lead lives they have reason to value [Why we need a global generic conceptual framework:  Self care =  transformation of Demand into Supply] Patient Reported Outcome Measures (PROMs) 'benefit' across Hodges' model? 'harm done' across Hodges' model? Shared Decision Making -  patient centred care,  choice, autonomy,  Right Care, Right Time, Right Place?*

A's.  Value = outcomes achieved – money spent (Porter) 1.Allocative value – how to allocate resources equitably in such a way that maximum value for the whole population is obtained 2.Technical value – increased value associated with improvements in quality and safety of healthcare 3.Personalised value – individual patient values, in combination with best evidence and assessments of the person’s condition. (Gray) Supply - Outcomes PROMS: hip replacement, knee replacement, groin hernia and varicose veins Right Care, Right Time, Right Place Chronic disease Improving medical technology

Demand Social determinants of health "Unlimited healthcare intervention provision may lead to increased harm." Friends and Family Test Person- and community-centred approaches, such as peer support, self-management education, health coaching, group activities and asset-based approaches. Local - Community - National Porter recommends classification of outcomes in three tiers [16]. Tier one is ‘Health status achieved or retained’, including measures such as survival at one or five years, or for those with life-limiting conditions, the degree of health or recovery achieved or maintained. Tier two, ‘Process of recovery’, includes the time taken to return to normal activities and disutility of care, such as errors and adverse events in care, incorrect diagnosis, and discomfort. Tier three is ‘Sustainability of health’ and includes recurrence and long-term consequences of treatment.

"The definition proposed by Gray ... defines value in healthcare as ‘the net benefit, that is the difference between the benefit and the harm done by a service, taking into account the amount of resources invested’" Supply - Outcomes Health Economics limited healthcare budgets Governments - Industries Relationships demand - drug costs Moving FROM: cost-effectiveness and pay for performance TO: Value-based pricing Healthcare-associated harm Value-based healthcare has the potential to be used in local and national priority setting and policy development.

*This brief paper provides a very good outline of value-based care. 'Mental' in this paper is mentioned early on in a definition of health, thereafter you will find 'mental' in funda-mental, environ-mental plus incre-mental. 'Mental health' and values-based care will no doubt be discussed elsewhere. This brief paper suggests however, that we really do need a generic conceptual framework for health and social care. To be fully-realised value-based care must also reach, encompass and incorporate mental health and public mental health.


Gentry S, Badrinath P (March 06, 2017) Defining Health in the Era of Value-based Care: Lessons from England of Relevance to Other Health Systems. Cureus 9(3): e1079. DOI 10.7759/cureus.1079

Editorial: Assuring the Capture of Standardized Nursing Data... Ponte, Somerville & Adams (2016)

In their editorial Ponte, Somerville and Adams (2016) focus on the US nursing care situation and contrast with the UK experience from the outset:

As the U.S. health system moves toward value-based care, chief nursing officers (CNOs) are pressured as never before to demonstrate nursing’s contributions to improving the cost, quality, and efficiency of care, key elements of the value equation. The shift from fee-for-service to value-based care and reimbursement has been made possible through the implementation of electronic health records (EHRs), and the emergence of Big Data analytics, in which payers and healthcare organizations mine the streams of data produced by clinical and administrative systems to understand and evaluate care inputs, processes, and outcomes (Westra, Clancy, et al., 2015).

The contrast is implicit and is not the purpose of the editorial: Assuring the Capture of Standardized Nursing Data: A Call to Action for Chief Nursing Officers. From a still summery Lancashire the above really does seem a continent away, if not a world. It should not be this way. Questions of value for money, the quality of nursing care and outcomes are also central here and digital aspirations are ongoing: NHS Digital.

Perhaps Hodges' model lacks appeal not just because of its historical (mid-1980s) qualities, but a 4x4 checkbox appearance that seeks to standardize care concepts and the nurse's approach? Not only that but maybe the model dictates where they should be placed? The push for data to 'let the light in' and make nursing visible, can also seem a major, externally driven and intrusive distraction from nursing care. That is, doing the job, being a nurse, nursing delivery, caring ...

That Assuring in the title is important. It is the kernel of recursion, the crucial check that is governance and engaged management. Not remote via a screen - dashboard, but in-process - in-situ assuring that the nursing role can and is delivering. In the dash to data vision can become blurred. Socio-technical perspectives are skewed, what might be termed holistic bandwidth is constrained as per the system.

Ensuring that standardized, encoded nursing data are captured in EHRs is critical if nursing is to realize the potential of big data analytics. Having nursing data available for analysis will allow us to gain a better understanding of nursing practice, demonstrate nursing’s contributions to patient care and outcomes, and facilitate evidence-based practice and nursing research. Indeed, we will no longer be driving blind. Rather, we will be driving smart.

Somewhere in this big data lies person centered, holistic and integrated care. This needs to be transformed to self-care. Can these incremental positive changes be captured (once debated and defined)? Will nurses be empowered with access to this data: the big, little and what lies between? Where are the analysts? Who makes the decisions based on this data? Is transparency assured?

As technology advances we have much to do in the UK, lest we nurses find ourselves sat in what has suddenly become a self-driving vehicle that is bound who knows where....


Ponte, P. R., Somerville, J. G., & Adams, J. M. (2016). Assuring the Capture of Standardized Nursing Data: A Call to Action for Chief Nursing Officers. International Journal of Nursing Knowledge, 27(3), 127.