Title: Blockchain Solutions for Managing Value-based Care: A Systematic Review (Preprint)

Abstract

BACKGROUND Value in healthcare has been defined as the health outcome per dollar of cost expended. However, the barrier to achieving the implementation of value-based health care (VBHC) lies in its many structural, technological, and economic challenges. Six steps have been identified by the early proponents of VBHC to move towards a high-value healthcare delivery system: organizing integrated practice units (IPUs), measuring cost/outcomes for patients, moving to bundled payments, integrating care delivery, expanding care services, and enabling a suitable technology platform. Blockchain, given its unique properties of decentralization, data storage, and user platform, shows promise as a technology that may help implement the steps to achieve VBHC. In this paper we turn to the literature surrounding blockchain technology to highlight and summarize existing and theoretical use cases that address one or more of these steps. OBJECTIVE Describe blockchain-based solutions that can be utilized for implementing steps to achieve value-based health care. METHODS Utilizing PRISMA methodology, a systematic review of blockchain articles pertaining to value-based care delivery using PubMed, IEEE Xplore, and Business Source Complete was performed from March and April of 2022 with no limitations on publication date. Articles included must 1) pertain to blockchain in healthcare and 2) include either an existing or theoretical/future use case for blockchain in implementing one of the six steps to achieve value-based healthcare as defined by Teisberg and Porter. RESULTS A total of 357 articles were identified from all three databases (87 from PubMed, 259 from IEEE Xplore, and 11 from Business Source Complete) with 288 articles excluded. There were 69 articles included in the review with all of them (69) discussing interoperability and 18 discussing scalability. No articles were found pertaining to the other 4 steps to achieve value-based health defined by Teisberg and Porter. CONCLUSIONS This study examined the literature for articles pertaining to blockchain and value-based healthcare. While blockchain is early in its development as a technology, there is a significant body of research discussing how blockchain’s interoperability can be leveraged to improve value-based delivery systems. There is still a lack of research evaluating other core areas of a value-based delivery system, particularly relating to integrated practice units, measuring costs and outcomes, and bundled payments.

Fecal microbiota and Clostridium transplantation: Strategies for intestinal balance

“…Further investigation into the mechanisms behind the success of FMT, including the identification of the specific bacteria responsible for the resolution of rCDI, is also needed. (56,57,58,59,60,61,62,63) In conclusion, the results of this review support the efficacy of FMT in the treatment of rCDI and provide valuable information on the restoration of intestinal balance. However, further research and rigorous clinical trials are required to fully understand the mechanisms behind these effects and to optimize treatment protocols.…”

Revision total hip prosthesis with a primary prosthesis without bone graft

“…(11,42,43,44,45) https://doi.org/10.56294/sctconf2023417 Se concluye que, el caso clínico destaca la necesidad de una atención individualizada y un enfoque adaptativo en el manejo de las prótesis totales de cadera, subrayando que un planteamiento y ejecución cuidadosos de los planes prequirúrgicos, intraoperatorios y postquirúrgicos pueden conducir a resultados satisfactorios y duraderos, incluso en situaciones poco frecuentes. (12,46,47,48,49)…”

Nutritional, anthropometric characteristics and the probability of suffering disorders of eating behavior in classical dancers in four academies of the central department

“…(11,44,45,46,47,48) Según los resultados obtenidos con el cuestionario de BULIMIA TEST (BULIT) de las cinco dimensiones evaluadas por esta herramienta (descontrol de las comidas, malestar, vómitos, tipos de alimentos, fluctuaciones en el peso) para identificar sintomatología y factores de riesgo de bulimia nerviosa, (12,48,49,50,51) el 90 % de las participantes presentaron bajo riesgo de padecer bulimia nerviosa, por otra parte se observa que en la ciudad de São Luís, MA, Brasil, adolescentes bailarinas 40,0 % presentó comportamiento de riesgo de bulimia nerviosa. (13,52,53,54,55,56,57) Entre las limitaciones del estudio, se mencionan el corto tiempo que se manejó para lograr recabar más datos y realizar un estudio más profundo, además de que la muestra era pequeña para poder extrapolar los resultados a todas las academias del Paraguay. Pero es una gran apertura para futuras investigaciones.…”