Background With the current trend in healthcare moving towards a more value‐based approach, it is essential to understand what value encompasses. Objectives To develop an actionable value‐based outcome set (VOS) for daily practice. Methods A mixed method approach was used consisting of four phases. Formerly, a systematic review was conducted, providing an overview of all patient‐relevant outcomes defined in current literature. These 23 outcomes were then presented to a group of patients, using a modified nominal group technique (NGT), to establish whether these results represented all of their relevant outcomes. Subsequently, these outcomes were ranked according to importance by patients attending our academic specialized psoriasis clinic. A review of the literature was performed to assess which instruments were available and suitable to evaluate the outcomes in this VOS. Finally, a pilot feasibility test was performed amongst patients. Results Of the 23 outcomes, two were omitted from the ranking exercise after the NGT. In the ranking exercise, 120 patients participated. The median age was 50.0 (IQR 25.0) years and 36.7% were female. Median PASI score was 2.4 (IQR 5.2), and treatments varied from topicals to biologicals. The outcomes scored as most important were symptom control, treatment efficacy, confidence in care and control of disease. The least important outcomes were comorbidity control, productivity and cost of care. A significant difference was shown between the ranking of the outcomes (p < 0.001). In total, 12 instruments were selected, which are reported by both patient and provider, to measure the outcomes in this VOS. Median completion time for the patient part was 30 min (IQR 2.8). Conclusions This VOS is a first proposal to evaluate psoriasis care in a value‐based manner. Measuring these outcomes can enable us to critically appraise and improve current care processes, within the reality of available resources, thereby increasing value for patients.

IMPORTANCEThere is a need to define which outcomes matter to patients with psoriasis to deliver value for the patient when managing their condition.OBJECTIVES To generate a comprehensive overview of all outcomes relevant in the management of psoriasis as defined by patients.EVIDENCE REVIEW A systematic review was performed by searching 3 databases (MEDLINE, Embase, and Web of Science) from August 1, 2019, until March 27, 2021, using a comprehensive search strategy consisting of 4 concepts including psoriasis, patients, outcomes, and relevance. A (citing) reference search was also performed of all retrieved articles. Two independent reviewers screened the retrieved records by title/abstract against the eligibility criteria. Studies were eligible for inclusion if they reported on the importance of outcomes for patients with psoriasis. No language restrictions were used. Data extraction and quality assessment were also performed independently. Quality assessment was done using the QUALSYST tool.FINDINGS In total, 10 365 records were screened for eligibility, of which 24 studies were included for synthesis. A total of 23 317 patients were evaluated, and 273 (154 unique) items were retrieved. These items were aggregated into 23 outcomes: (almost) complete clearance; symptom control; difficult location clearance; time to clearance; treatment efficacy, sustainability, safety, tolerability, and convenience; comorbidity control; daily and social activity; emotional well-being; intimate relationships; productivity; health-related quality of life; confidence in care; control of disease; communication with care professional; information from other sources than care professional; and cost of care (societal and for the patient). These were then further grouped into 4 core areas: physical/clinical, life impact, resource use, and adverse effects. The mean overall quality of the studies was 75.6% (range, 35.7%-100%).CONCLUSIONS AND RELEVANCE This systematic review analyzed patient-relevant outcomes reported in patients with psoriasis to aid in the transition to a value-based treatment approach.

There is a need to revise current healthcare organization due to the ever-rising costs and variation in quality of delivered care. Over the past decades there have been several strategic frameworks attempting to tackle this problem. Value-based healthcare (VBHC) is one those frameworks which has gained increasing popularity the last years. The framework is formulated on the premise that the healthcare sector should deliver integrated care, using integrated practice units (IPUs), and strive to maximize the value created. Value in this context is defined as the health outcomes achieved per costs made. We have designed a lean IPU called PsoPlus in which psoriasis patients are managed by a multidisciplinary team which has all the expertise and skill to manage psoriasis and its associated conditions. In addition, we have developed and implemented guidelines for the management of psoriasis associated comorbidities enabling us to deliver integrated care in the Belgian healthcare setting. Finally, we have designed a supporting information technology platform, called PsoSmart, that brings data from patients and healthcare providers together and provides actionable insights for clinical decision making. The created value is documented and captured using a value-based outcome set. Cost assessments at the individual patient level are also performed. To conclude, we describe here a comprehensive IPU setting for psoriasis which incorporates the VBHC principles. This IPU goes further and delivers a higher level of integrated care than other multidisciplinary psoriasis clinics. Monitoring outcomes and costs provides us with further insights to optimize psoriasis care. In addition, a software program designed to enhance psoriasis care is being developed further, however, advances in healthcare technology are needed.