This thesis shows that quality of colorectal cancer care is irrevocably associated with hospital costs. Although surgical auditing is a cost and time-consuming exercise, it has a strong potential... Show moreThis thesis shows that quality of colorectal cancer care is irrevocably associated with hospital costs. Although surgical auditing is a cost and time-consuming exercise, it has a strong potential to improve outcomes in healthcare and simultaneously reduce hospital costs. Comparing hospital performances on both quality and costs makes identification of ‘best practice’ hospitals possible. Moreover, providing combined quality-cost outcomes of frail patients or operation techniques provides valuable insights where to start quality improvement initiatives. Finally, rewarding healthcare providers based on operative risk could be a first step in developing powerful reimbursement systems. This all might catalyze the continuous improvement of value leading to a more sustainable healthcare system in the future. Show less
The essence of VBHC is to improve patients' outcomes at lower costs. This thesis attempts to construct the value quotient (vQ) for IBD: a metric for value which incorporates patient value, defined... Show moreThe essence of VBHC is to improve patients' outcomes at lower costs. This thesis attempts to construct the value quotient (vQ) for IBD: a metric for value which incorporates patient value, defined as a combination of disease control, quality of life, and productivity in the numerator, and divides it by the associated IBD-related costs in the denominator. In this thesis we showed the feasibility of monitoring clinical disease control remotely using a mobile app, we showed the impact of IBD on work productivity, and we developed a patient-centric composite score that incorporates all three outcomes as well as individual patient preferences. However, metrics for long term outcomes still need to be incorporated in the vQ. Although ideally this would be done by measuring disease outcomes long-term, this is not practical for short-term improvements. Process measures that are associated with long term outcomes and that are well-grounded in the medical literature offer a feasible short term alternative. Future research is needed to assess which process measures would be appropriate in this context, and to develop a quantifiable way to include these in the vQ. Show less
