Cure for increasing health care costs: The Bernhoven case as driver of new standards of appropriate care

Leersum, N. van; Bennemeer, Peter; Otten, M.; Visser, Sander; Klink, Ab; Kremer, J.A.M.

doi:10.1016/j.healthpol.2019.01.002

Cited by 27 publications

(32 citation statements)

References 7 publications

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“…However, the impact on revenue may also apply in other contexts, as found in a Dutch study that describes financial interests of HCPs as one of many barriers towards SDM implementation in multidisciplinary sciatica care [ 26 ]. New evidence that payment structures influence SDM implementation comes from an example in the Netherlands, where better and more patient-centered care at lower costs was achieved by moving away from fee-for-service payment model, and by changing hospital structures and culture [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

“All about the money?” A qualitative interview study examining organizational- and system-level characteristics that promote or hinder shared decision-making in cancer care in the United States

2020

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Background Despite decades of ethical, empirical, and policy support, shared decision-making (SDM) has failed to become standard practice in US cancer care. Organizational and health system characteristics appear to contribute to the difficulties in implementing SDM in routine care. However, little is known about the relevance of the different characteristics in specific healthcare settings. The aim of the study was to explore how organizational and health system characteristics affect SDM implementation in US cancer care. Methods We conducted semi-structured interviews with diverse cancer care stakeholders in the USA. Of the 36 invited, 30 (83%) participants consented to interview. We used conventional content analysis to analyze transcript content. Results The dominant theme in the data obtained was that concerns regarding a lack of revenue generation, or indeed, the likely loss of revenue, were a major barrier preventing implementation of SDM. Many other factors were prominent as well, but the view that SDM might impair organizational or individual profit margins and reduce the income of some health professionals was widespread. On the organizational level, having leadership support for SDM and multidisciplinary teams were viewed as critical to implementation. On the health system level, views diverged on whether embedding tools into electronic health records (EHRs), making SDM a criterion for accreditation and certification, and enacting legislation could promote SDM implementation. Conclusion Cancer care in the USA has currently limited room for SDM and is prone to paying lip service to the idea. Implementation efforts in US cancer care need to go further than interventions that target only the clinician-patient level. On a policy level, SDM could be included in alternative payment models. However, its implementation would need to be thoroughly assessed in order to prevent further misdirected incentivization through box ticking.

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Section: Discussionmentioning

confidence: 99%

“All about the money?” A qualitative interview study examining organizational- and system-level characteristics that promote or hinder shared decision-making in cancer care in the United States

2020

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“…This observational study assessed the open-label non-mandatory transition from EO to EB at the Rheumatology Department of Bernhoven, a general hospital in Uden, in the south of The Netherlands. Since 2015, Bernhoven has been actively promoting the shared decision-making strategy, in an attempt to improve shared decision-making in the hospital [ 14 ]. The transition was part of the usual care delivered at Bernhoven and, as such, shared decision-making was an important part of the transitioning to the EB.…”

Section: Methodsmentioning

confidence: 99%

One-year results after transitioning from etanercept originator to biosimilar in a setting promoting shared decision-making in rheumatology

Müskens

Dartel

Teerenstra

et al. 2020

Rheumatology Advances in Practice

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Objective Study the effect of non-mandatory transitioning from etanercept originator to etanercept biosimilar on retention rates in a shared decision making-promoting setting. Methods In 2016 all patients treated with etanercept originator and stable disease at the Rheumatology department in Bernhoven were offered transitioning to etanercept biosimilar by opt-in approach. A historical cohort of patients treated with etanercept originator in 2015 was identified as control group. Etanercept discontinuation was compared between the cohorts using Cox-regression. To study the nocebo-effect reasons for discontinuation were categorized into objective reasons (e.g., laboratory abnormalities, increase in swollen joint count, allergic reaction) and "subjective health complaints" (symptoms only perceptible to the patient, e.g., tiredness, arthralgia). An adjusted Kaplan-Meier curve for retention of the etanercept biosimilar was made, censoring subjective health complaints as reason for discontinuation. Results 70 of the 79 patients eligible for transitioning agreed to transition (89%). The one year crude retention rate of etanercept in the transition cohort was 73% (95% CI 0.62-0.83), compared to a retention rate of 89% (95% CI 0.81-0.95) in the historical cohort, p-value= 0.013. This resulted in a higher risk of treatment discontinuation in the transition cohort (adjusted hazard ratio=2.73; 95%CI 1.23-6.05, p-value= 0.01). After adjusting for the nocebo-effect, the cohorts had comparable retention rates (86% vs. 89%, p-value= 0.51). Conclusion Non-mandatory transition from etanercept originator to its biosimilar using an opt-in approach in a shared decision-making promoting setting resulted in a higher discontinuation of etanercept compared to the historical cohort. This could largely be attributed to the nocebo-effect.

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“…This paper consequently addresses the discourse regarding the importance of organization and management practice in healthcare (Ramanujam and Rousseau, 2006) in suggesting that the ability to facilitate healthcare professionals' professional fulfilment when organizing care inspired by the "value shop" is another factor that needs to be taken into consideration when evaluating the potential outcomes and benefits of such organizing. In addition to having the potential to mitigate patients' experience of care as fragmented, reduce its cost and achieve higher-quality (Gui et al, 1995;Tang and Lee, 2009;Moore et al, 2009;Bredenhoff et al, 2010;Cook et al, 2014;King, 2016;Friedemann Smith et al, 2019;van Leersum et al, 2019), organizing care inspired by the "value shop" may have a profound impact upon how healthcare professionals experience their own role and function in the provision of care. Whereas the Swedish healthcare system is to some extent idiosyncratic, the degree of public funding being one of its characteristics (OECD, 2015), the challenges associated with a more fragmented healthcare system as a result of recent reforms is an international phenomenon (Eriksson et al, 2020).…”

Section: Concluding Discussionmentioning

confidence: 99%

Providing healthcare through “value shops”: impact on professional fulfilment for physicians and nurses

Gadolin

Andersson

Eriksson

et al. 2020

IJHG

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PurposeThe purpose of this paper is to empirically explore and demonstrate the ability of healthcare professionals to attain professional fulfilment when providing healthcare inspired by “value shops”.Design/methodology/approachA qualitative case study incorporating interviews and observations was conducted.FindingsThe empirical data suggest that the professional fulfilment of both physicians and nurses is facilitated when care is organized through “value shops”. Both groups of professionals state that they are able to return to their “professional core”.Originality/valueThe beneficial outcomes of organizing healthcare inspired by the “value shop” have previously been explored in terms of efficiency and quality. However, the professional fulfilment of healthcare professionals when providing such care has not been explicitly addressed. Professional fulfilment is vital in order to safeguard high-quality care, as well as healthcare professionals' involvement and engagement in implementing quality improvements. This paper highlights the fact that care provision inspired by the “value shop” may facilitate professional fulfilment, which further strengthens the potential positive outcomes of the “value shop” when utilized in a healthcare setting.

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Cure for increasing health care costs: The Bernhoven case as driver of new standards of appropriate care

Cited by 27 publications

References 7 publications

“All about the money?” A qualitative interview study examining organizational- and system-level characteristics that promote or hinder shared decision-making in cancer care in the United States

“All about the money?” A qualitative interview study examining organizational- and system-level characteristics that promote or hinder shared decision-making in cancer care in the United States

One-year results after transitioning from etanercept originator to biosimilar in a setting promoting shared decision-making in rheumatology

Providing healthcare through “value shops”: impact on professional fulfilment for physicians and nurses

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