Vers une évaluation des résultats des soins hospitaliers : intégration des coûts, des complications médicales et des résultats issus du patient dans un benchmarking
(2024)
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- (en) Today, Belgium is seeking to propose reforms to integrate quality into hospital financing, with a P4P (Pay for Performance) program introduced in 2018. The international literature review highlights quality policies with specific approaches in each country, implementing strategies such as "Pay for Performance" (P4P) and "Value-Based Purchasing" (VBP). However, Belgium is currently facing serious difficulties in evaluating the performance related to the care pathway in hospitals. There is a lack of clarity on the cost-quality relationship, the absence of medico-economic benchmarking, underutilization of Patient-Reported Outcome Measures (PROMs), the lack of adjustment of data to the hospital case mix, and the absence of an evaluation of the severity of medical complications. The aim of the thesis is to assess the feasibility of comparing hospital care across different hospitals using outcome indicators such as costs, medical complications, and patient-reported outcomes. Through this inquiry, the research proposes a conceptualization of value at the level of care pathways in hospitals, focusing on hospital benchmarking. The work has led to the development of an innovative composite indicator, standardizing outcome measures and adjusting results for case mix index. The correlation of these parameters has, in our view, provided an overall assessment of a given pathology and offered a more objective basis for inter-hospital benchmarking. The level of detail in our benchmarking sheds light on practical areas for improvement or, conversely, encourages best practices in the field. The developed methodology and composite indicator are simple, calculable, and easily interpretable for stakeholders, thus facilitating their integration into daily hospital practice. The approach emphasizes transparency, communication of results to relevant stakeholders, and underscores the importance of regular feedback to improve the quality of care. The pragmatic approach proposes a progressive analysis, moving from macro to micro levels, examining cost indicators, medical complications, and patient-reported outcomes. The Donabedian model has been utilized to illustrate the breakdown of these indicators. At the end of this work, we are able to propose some recommendations.
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Dehanne, F. (2024). Vers une évaluation des résultats des soins hospitaliers : intégration des coûts, des complications médicales et des résultats issus du patient dans un benchmarking. https://hdl.handle.net/2078.5/233550