@article{ref1,
title="Tackling the frailty burden with an integrative value-based approach: results from a mixed-methods study",
journal="Journal of public health (Heidelberg)",
year="2022",
author="Fürstenau, Daniel and Haneke, Hannah and Spies, Claudia and Walz, Tim and Schewina, Kai and Höft, Moritz and Mörgeli, Rudolf and Balzer, Felix",
volume="30",
number="1",
pages="99-110",
abstract="Aim  The purpose of this paper is to investigate the implementation of value-based care principles in the context of frailty in the perioperative process, highlighting the importance of an integrative perspective considering medical and patient-centric outcomes as well as costs.   Subject and methods  This mixed-methods study employs a sequential design. Qualitative observational data were used to identify needs and barriers for implementing value-based principles, and quantitative methods were subsequently used to demonstrate the value of employing such an approach using data gathered from n = 952 patients. Propensity score matching was applied to identify the frailty-associated costs of the inpatient setting for n = 381 non-frail and n = 381 (pre-)frail patients, in particular considering patient-centric outcomes.   Results  The qualitative analysis identified three main challenges when implementing value-based principles in the context of perioperative care and frailty, namely challenges related to the cost, patient-centric, and integrative perspectives. In addressing these shortcomings, a quantitative analysis of a propensity score-matched sample of patients undergoing surgery shows additional frailty-associated costs of 3583.01 [1654.92; 5511.04] EUR for (pre-)frail patients and the influence of individual patient-centric attributes. Effect size Cohen's d was 0.26.   Conclusion  The results demonstrate that frailty should be considered from an integrative perspective, taking cost, patient-centered outcomes, and medical outcomes into account simultaneously. The results also show the value of a research design which uses qualitative data for the identification of needs and barriers, as well as quantitative data for demonstrating the usefulness of the conceived value-based approach to perioperative care delivery.<p /> <p>Language: en</p>",
language="en",
issn="0943-1853",
doi="10.1007/s10389-021-01647-2",
url="http://dx.doi.org/10.1007/s10389-021-01647-2"
}