Does value-based healthcare support patient-centred care? A scoping review of the evidence

Abstract

Background: Standardisation of outcome measures is integral to value-based healthcare (VBHC), which may conflict with patient-centred care, focusing on personalisation.

Objectives: We aimed to provide an overview of measures used to assess the effect of VBHC implementation and to examine to what extent the evidence indicates that VBHC supports patient-centred care.

Design: A scoping review guided by the Joanna Briggs Institute methodology.

Sources of evidence: We searched the following databases on 18 February 2021: Cochrane Library, EMBASE, MEDLINE and Web of Science.

Eligibility criteria: We included empirical papers assessing the effect of the implementation of VBHC, published after introduction of VBHC in 2006.

Data extraction and synthesis: Two independent reviewers double-screened papers and data were extracted by one reviewer and checked by the other. We classified the study measures used in included papers into six categories: process indicator, cost measure, clinical outcome, patient-reported outcome, patient-reported experience or clinician-reported experience. We then assessed the patient-centredness of the study measures used.

Results: We included 39 studies using 94 unique study measures. The most frequently used study measures (n=72) were process indicators, cost measures and clinical outcomes, which rarely were patient-centred. The less frequently used (n=20) patient-reported outcome and experience measures often measured a dimension of patient-centred care.

Conclusion: Our study shows that the evidence on VBHC supporting patient-centred care is limited, exposing a knowledge gap in VBHC research. The most frequently used study measures in VBHC research are not patient-centred. The major focus seems to be on measures of quality of care defined from a provider, institution or payer perspective.

Keywords: health policy; health services administration & management; organisation of health services; patient-centered care.