Value-based medicine: concepts and application

Jong-Myon Bae

doi:10.4178/epih/e2015014

Articles

Page Path: HOME > Epidemiol Health > Volume 37; 2015 > Article

Methods Value-based medicine: concepts and application: Jong-Myon Bae; Epidemiol Health 2015;37:e2015014.
DOI: https://doi.org/10.4178/epih/e2015014
Published online: March 4, 2015

Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea

Correspondence: Jong-Myon Bae Department of Preventive Medicine, Jeju National University School of Medicine, 102 Jejudaehak-ro, Jeju 690-756, Korea Tel: +82-64-755-5567, Fax: +82-64-725-2593, E-mail: jmbae@jejunu.ac.kr

• Received: December 24, 2014 • Accepted: March 4, 2015

This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

22,872 Views
367 Download
20 Web of Science
51 Crossref

Full Article

Download PDF

Abstract
INTRODUCTION
BODY
CONCLUSION AND SUGGESTIONS
ACKNOWLEDGEMENTS
NOTES
SUPPLEMENTARY MATERIAL
REFERENCES

Abstract

Global healthcare in the 21st century is characterized by evidence-based medicine (EBM), patient-centered care, and cost effectiveness. EBM involves clinical decisions being made by integrating patient preference with medical treatment evidence and physician experiences. The Center for Value-Based Medicine suggested value-based medicine (VBM) as the practice of medicine based upon the patient-perceived value conferred by an intervention. VBM starts with the best evidence-based data and converts it to patient value-based data, so that it allows clinicians to deliver higher quality patient care than EBM alone. The final goals of VBM are improving quality of healthcare and using healthcare resources efficiently. This paper introduces the concepts and application of VBM and suggests some strategies for promoting related research.
Keywords: Evidence-based medicine, Evidence-based practice, Quality of life, Value of life, Decision support techniques

INTRODUCTION

Evidence-based medicine (EBM) became the prevailing medical paradigm in the post-1990s era. At the core of EBM is clinical decision-making based on the best available research evidence rather than a clinician’s expertise to minimize the uncertainties of clinical examinations [1,2]. In an effort to help clinicians utilize the newest and highest quality research evidence, The Evidence-Based Medicine Working Group [3] suggested a five-level grading system for assessing the quality of evidence [1].

However, a different viewpoint soon followed that the best evidence alone is not always sufficient for making the most rational clinical judgments and decisions. Accordingly, clinicians’ expertise pertaining to the particulars of the circumstances at hand and patients’ values should also be considered in the decision-making process [4]. Incorporating this point of view, the definition of EBM was modified to “the integration of best research evidence with clinical expertise and patient values” [5]. Subsequently, the likelihood of being helped or harmed index was developed, which reflects patients’ expectations regarding the benefits and risks of treatment options. Despite such efforts, the EBM paradigm still poses limitations in actively incorporating health-related quality of life (HRQoL) [6] and patients’ preferences into the realm of medicine and public health [7].

Despite the advantage of producing the highest quality evidence, the efficacy of randomized clinical trials fails to provide a true indication of clinical effectiveness. In this light, patient-centered care (PCC) started to gain momentum, where patients as medical consumers participate in the decision-making process (shared decision-making) and evaluation of treatment outcomes (patient-reported outcomes) [8]. Furthermore, PCC corresponds to comparative effectiveness research (CER) and its goals of achieving maximum benefit per cost [9]. PCC is also in accordance with the principles of medical ethics [10]. Finally, PCC strives to improve healthcare quality through integration of patient values in medical care [11].

According to this backdrop, Brown et al. [12] elaborated on the three major trends of EBM, PCC, and CER in 21st century healthcare. As the movement to actively integrating patient preferences (values) into clinical practice takes hold, value-based medicine (VBM) has emerged in order to stress a medicine based on values as well as research evidences. In early years, it was also referred to as “humanized medicine” because its core concept of integrating scientific research and patient values is congruent to the principles of medical ethics [13]. The present paper aims to introduce the concept of VBM to the Korean healthcare system and make recommendations about its potential applications.

Value-based medicine: definition and objectives: The term “value-based” was first introduced by a team of researcher led by Dr. Brown at the Center for Value-Based Medicine at Pennsylvania State University [14]. The team defined VBM as “the practice of medicine incorporating the highest level of evidence-based data with the patient-perceived value conferred by healthcare interventions for the resources expended” [15,16]. In the above sentence, three major components of VBM are highlighted [17]. First, EBM principles are thoroughly selected based on the best research evidence available and applied as treatment options. Second, patients’ values are converted into measurable utility values to facilitate the integration. Third, the cost-utility level expected from selecting a particular treatment option is the basis for decision-making. In other words, the ultimate goal pursued by VBM is to provide cost effective, science-based healthcare that incorporates patient values [7,14]. Petrova et al. [13] suggested 10 principles that can be applied in clinical settings to achieve these goals.
Values and utility in healthcare: The dictionary definition of “value” is “relative worth, utility, or importance” [9]. Its operational definition varies depending on the agents who assign values such as in patient and social values [13,14,18]. Considering that VBM focuses on patient values, the definition of values here concerns (1) increased life expectancy or (2) increased HRQoL [7]. Increased life expectancy can easily be measured by concrete indexes such as survival rate. However, measuring HRQoL improvements poses yet another challenge [19].; Numerous tools have been developed to measure HRQoL that have been applied in various fields [20]. These tools can be classified into function-based and preference-based tools [14], and the measurement based on preference is referred to as “utility” [15]. In other words, values that judiciously reflect patient preferences are connected to utility by HRQoL [9,16]. On a side note, “utility” in the context of healthcare is based on von Neumann-Morgenstern’s utility theorem, which concerns individuals’ decision-making processes amid uncertainties [21]. In a similar vein, utility in our context can be interpreted as the level to which an individual’s choice reflected upon trade-off between the potential benefits and risks under circumstances in which uncertainties abound [16,22].
Utility value and utility score: Utility value is obtained by measuring patient preference levels, with “0” indicating death, by far the worst case scenario in healthcare, and “1” indicating perfect health [17,23,24]. To measure the utility values that correspond to various disease conditions, the standard gamble, time trade-off, and rating scale methods were developed [22,25]. Among them, the time trade-off method is the most commonly used in VBM research for its easy comprehensibility, validity, and repeatability [6,9,14,15,23]. To compare some outcomes, the measuring method should be verified [16] because these methods have been developed out of different theoretical backgrounds [26].; The utility value is the benefit level at a specific point in time (age), which means it can vary over time [27]. That is, it is necessary to weight time points in different health states, which vary with age [25]. The utility value does not consider life expectancy; therefore, incorporating the additional element of life expectancy would render a more faithful healthcare value [16]. Reflecting this viewpoint, quality-adjusted life years (QALY), disability-adjusted life years, healthy-year equivalents, and health-adjusted life expectancy have been developed [15] whose calculated indexes are called utility scores [22]. QALY, which is calculated by multiplying year(s) of life by utility value(s), is the most widely used value index in healthcare and related research efforts [22]. In VBM, the total value of medical intervention is calculated using a decision tree model and QALY [2,15]. Links to more information on the principles behind the development of QALY, calculation method, advantages, and disadvantages can be found in the references section of this paper [17,24].
Value-based medicine application steps: Brown et al. [15] suggested seven steps for the research process. However, I suggest restructuring the process into four steps, which are shown in Table 1 along with the research methodologies and concepts applied to each step.; Steps 1 and 2, in which evidence is searched and evaluated upon the construction of a clinical problem, are identical to the flow of Ask, Acquire, and Appraisal on EBM 5A steps [1,28]. When implementing VBM for the purpose of selecting a medical intervention, it is important to clarify the items pertaining to comparison (comparators) among the population, intervention, comparators and outcome parameters (PICO) applied in Step 1. Once evidences about economic feasibility were acquired in Step 2, its validity, impact, and applicability are evaluated for utilization [29,30]. In this step, it must be verified whether the information required for the cost analysis and decision tree in Step 3 – cost, utility value, and utility level – can be acquired, and the result should be reflected in the next step.; Step 3 concerns the cost-utility analysis (CUA), which is the core of VBM research [31,32]. CUA, a method of economic evaluation, used to concern a concept that clearly differed from what was handled by cost-effective analysis (CEA) [24]. Recently, however, it tends to be viewed as a method incorporated into CEA [33]. Nevertheless, QALY is an index that was developed to reflect utility in the first place. Therefore, it makes sense to classify the research concerning money per QALY as CUA for data comparisons and valid interpretations [31,34]. CUA involves separate calculation processes of cost and utility. In Steps 3a and 3b, a decision tree is used to calculate the total utility value and QALY as in the provided example [7,32,35]. For information about the types of costs and discount rates needed in Step 3c, please refer to the references pertaining to economic evaluation [14,16,24,36].; Regarding the discount rate, it should be noted that an identical discount rate is used for both the cost and utility value gained and that the most recent year’s data are not applicable [15,37]. In recent years, a new index called ‘return on investment’ has been suggested for the purpose of financial assessment [38]. In Step 3d, the cost-utility ratio, as the ultimate product of CUA, is calculated and expressed as the money per QALY unit [16, 23,39,40]. Until the mid-2000s, decisions were made based on a fixed money amount per QALY unit [41,42]. However, this has recently been criticized for being irrational [43,44]. The use of incremental CUR, which compares the disparity between treatment alternatives, appears to be more suitable [15].; Finally, in Step 4, a sensitivity test is performed to eliminate uncertainties and enable reasonable data interpretation [2]. Through this process, outcome stability is verified even if the assumptions or applied utility levels change [24]. If reporting the above results in a paper, please refer to the suggestions by Siegel et al. [45] and the Task Force on Principles for Economic Analysis of Health Care Technology [46].
Usefulness and limitations of value-based medicine: VBM actively embraces patient values and quality of life, which were overlooked by EBM [13,17]. VBM has great potential to improve the quality of healthcare [47] since it is both congruent with the principles of medical ethics [13] and capable of reducing the uncertainties of clinical decisions [22]. Additionally, VBM is in accordance with the goals of health economics [14,24] since it facilitates an efficient allocation of resources by prioritizing the options by maximum utility per cost [14,15,23,32].; Nevertheless, VBM has its limitations since it concerns values [15,16,22,23]. First, the various values pursued by various involved agents, such as medical service providers, insurance providers, and policy makers, are likely to conflict with each other. Second, although patient values are prioritized, patients may exhibit a number of different values, which may change over time. Third, the availability of a variety of treatment options for accompanying diseases may not be guaranteed. Fourth, there is no standardized database available regarding utility values, which can provide an indication about quality of life. Fifth, the threshold set for the cost-utility ratio is unclear. Sixth, comparisons are impossible between countries with different economic structures and healthcare delivery systems.

CONCLUSION AND SUGGESTIONS

As seen to date, VBM expands on EBM by incorporating CUA to provide healthcare that reflects patient values (preferences) [9,14,22,23]. The ultimate goals of VBM are improved healthcare quality and effective and efficient utilization of healthcare resources [15].

To help the Korean healthcare system successfully actualize the goals of VBM, I offer a few strategic recommendations. First, collaborative clinical epidemiologic research is needed to establish a utility value database centered on major diseases that incorporates the time trade-off methods [1,14]. The patient QALY by disease and QALY league tables can be calculated and established only upon acquiring such a database [48]. In the process, participants who represent patient groups will have to be selected and reference case values will have to be collected [15,35]. Second, a healthcare system should be embraced that actively adopts clinical decision-making processes based on patient preferences. This means that the current common practice of offering a hustled explanation about treatment options and then obtaining written patient consent must be re-examined to offer healthcare that can actively incorporate patient values under uncertain circumstances [2]. To achieve this goal, decision aids that improve patients’ understanding their diseases personally will require development [49,50]. Last, to the greatest extent possible, a consistent application of standardized VBM research is recommended [14,17,32].

ACKNOWLEDGEMENTS

This study was made possible by the 2014 Jeju University research fund support project.

NOTES

The author has no conflicts of interest to declare for this study.

SUPPLEMENTARY MATERIAL

Supplementary material is available at http://www.e-epih.org/.

epih-37-e2015014-supplementary.pdf

Table 1.

Four steps of applying value-based medicine

Step	Action	Related methods and concepts
1	Asking an answerable question	P opulation, intervention, comparators and outcome parameters
2	Confirming the best evidence	comparators and outcome parameters
3	Gathering the numerical values	Cost-utility analysis
3a	Measuring the utility value	Time trade-off
3b	Calculating the total value	Decision tree and QALY
3c	Estimating costs	Cost analysis with discounting
3d	Calculating cost-utility ratios	Cost per QALY
4	Handling uncertainty	Sensitivity analysis

Modified from Brown et al. Evidence-based to value-based medicine. Chicago: AMA Press; 2005 [15].

QALY, quality-adjusted life years.

REFERENCES

1. Bae JM, Park BJ, Ahn YO. Perspectives of clinical epidemiology in Korea. J Korean Med Assoc 2013;56:718-723 (Korean).Article
2. Bae JM. The clinical decision analysis using decision tree. Epidemiol Health 2014;36:e2014025.Article PubMed PMC
3. Evidence-Based Medicine Working Group. Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA 1992;268:2420-2425.Article PubMed
4. Haynes RB, Devereaux PJ, Guyatt GH. Clinical expertise in the era of evidence-based medicine and patient choice. ACP J Club 2002;136:A11-A14.Article
5. Straus SE, Glasziou P, Richardson WS, Haynes RB. Evidence-based medicine: how to practice and teach it. 4th. Edinburgh: Elsevier Churchill Livingstone; 2011. p 1-12.
6. Stein JD, Brown MM, Brown GC, Hollands H, Sharma S. Quality of life with macular degeneration: perceptions of patients, clinicians, and community members. Br J Ophthalmol 2003;87:8-12.Article PubMed PMC
7. Brown MM, Brown GC, Brown HC, Irwin B, Brown KS. The comparative effectiveness and cost-effectiveness of vitreoretinal interventions. Curr Opin Ophthalmol 2008;19:202-207.Article PubMed
8. Bae JM. Global trends in the use of nationwide big data for solving healthcare problems. J Korean Med Assoc 2014;57:386-390 (Korean).Article
9. Brown MM, Luo B, Brown HC, Brown GC. Comparative effectiveness: its role in the healthcare system. Curr Opin Ophthalmol 2009;20:188-194.Article PubMed
10. Yoo SH, Lee J, Lee K, Lee I, Bae JM. Ethical principles and practice guidelines concerning the usage of public database for medical researches. J Korean Med Assoc 2013;56:1031-1038 (Korean).Article
11. Bae JM, Jung SE, Park BJ. A case study of Institute of Medicine for developing strategies of National Academy of Medicine of Korea. Health Policy Forum 2014;12:104-110 (Korean).
12. Brown GC, Brown MM, Sharma S. Health care in the 21st century: evidence-based medicine, patient preference-based quality, and cost effectiveness. Qual Manag Health Care 2000;9:23-31.Article PubMed
13. Petrova M, Dale J, Fulford BK. Values-based practice in primary care: easing the tensions between individual values, ethical principles and best evidence. Br J Gen Pract 2006;56:703-709.PubMed PMC
14. Brown MM, Brown GC. Update on value-based medicine. Curr Opin Ophthalmol 2013;24:183-189.Article PubMed
15. Brown MM, Brown GC, Sharma S. Evidence-based to value-based medicine. Chicago: AMA Press; 2005. p 5-7, 125-149, 151-181, 193-217, 267-279, 319-324.
16. Brown MM, Brown GC, Sharma S, Landy J. Health care economic analyses and value-based medicine. Surv Ophthalmol 2003;48:204-223.Article PubMed
17. Brown GC, Brown MM, Sharma S, Brown H, Smithen L, Leeser DB, et al. Value-based medicine and ophthalmology: an appraisal of cost-utility analyses. Trans Am Ophthalmol Soc 2004;102:177-185.PubMed PMC
18. Barthel HJ. Evidence-based medicine: the way to cost-effective, quality medical care. US Army Med Dep J 2007;63-68.PubMed
19. Unruh ML, Weisbord SD, Kimmel PL. Health-related quality of life in nephrology research and clinical practice. Semin Dial 2005;18:82-90.Article PubMed
20. Vetter TR. A primer on health-related quality of life in chronic pain medicine. Anesth Analg 2007;104:703-718.Article PubMed
21. Torrance GW. Preferences for health outcomes and cost-utility analysis. Am J Manag Care 1997;3 Suppl:S8-S20.
22. Birch S, Ismail AI. Patient preferences and the measurement of utilities in the evaluation of dental technologies. J Dent Res 2002;81:446-450.Article PubMed
23. Brown MM, Brown GC, Sharma S. Value-based medicine and vitreoretinal diseases. Curr Opin Ophthalmol 2004;15:167-172.Article PubMed
24. Kim CM. Health economics and outcomes research. Korean J Fam Med 2009;30:577-587 (Korean).Article
25. Burrows C, Brown K. QALYs for resource allocation: probably not and certainly not now. Aust J Public Health 1993;17:278-286.Article PubMed
26. Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes. 3rd. Oxford: Oxford University Press; 2005. p 140-147.
27. Bravo Vergel Y, Sculpher M. Quality-adjusted life years. Pract Neurol 2008;8:175-182.Article PubMed
28. Sackett DL. Clinical epidemiology. what, who, and whither. J Clin Epidemiol 2002;55:1161-1166.Article PubMed
29. O’Brien BJ, Heyland D, Richardson WS, Levine M, Drummond MF. Users’ guides to the medical literature. XIII. How to use an article on economic analysis of clinical practice. B. What are the results and will they help me in caring for my patients? Evidence-Based Medicine Working Group. JAMA 1997;277:1802-1806.Article PubMed
30. Vogel B, Gilbert SM, Boylston Herndon J, Dahm P. Advanced topics in evidence-based urologic oncology: economic analysis. Urol Oncol 2011;29:454-461.Article PubMed
31. Brown GC, Brown MM, Sharma S. Health care economic analyses. Retina 2004;24:139-146.Article PubMed
32. Brown MM, Brown GC, Lieske HB, Lieske PA. Preference-based comparative effectiveness and cost-effectiveness: a review and relevance of value-based medicine for vitreoretinal interventions. Curr Opin Ophthalmol 2012;23:163-174.Article PubMed
33. Griebsch I, Coast J, Brown J. Quality-adjusted life-years lack quality in pediatric care: a critical review of published cost-utility studies in child health. Pediatrics 2005;115:e600-e614.Article PubMed
34. Birch S, Gafni A. Cost effectiveness/utility analyses. Do current decision rules lead us to where we want to be? J Health Econ 1992;11:279-296.Article PubMed
35. Gupta OP, Brown GC, Brown MM. A value-based medicine cost-utility analysis of idiopathic epiretinal membrane surgery. Am J Ophthalmol 2008;145:923-928.Article PubMed
36. Brown GC. Vision and quality-of-life. Trans Am Ophthalmol Soc 1999;97:473-511.PubMed PMC
37. Weinstein MC, Siegel JE, Gold MR, Kamlet MS, Russell LB. Recommendations of the Panel on Cost-effectiveness in Health and Medicine. JAMA 1996;276:1253-1258.Article PubMed
38. Brown MM, Brown GC, Lieske HB, Lieske PA. Financial return-on-investment of ophthalmic interventions: a new paradigm. Curr Opin Ophthalmol 2014;25:171-176.Article PubMed
39. Brown MM. Health care economic analyses. Curr Opin Ophthalmol 2003;14:117-121.Article PubMed
40. Chapman RH, Berger M, Weinstein MC, Weeks JC, Goldie S, Neumann PJ. When does quality-adjusting life-years matter in cost-effectiveness analysis? Health Econ 2004;13:429-436.Article PubMed
41. Laupacis A, Feeny D, Detsky AS, Tugwell PX. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ 1992;146:473-481.PubMed PMC
42. Schackman BR, Gold HT, Stone PW, Neumann PJ. How often do sensitivity analyses for economic parameters change cost-utility analysis conclusions? Pharmacoeconomics 2004;22:293-300.Article PubMed
43. Brown MM, Brown GC, Sharma S, Garrett S. Evidence-based medicine, utilities, and quality of life. Curr Opin Ophthalmol 1999;10:221-226.Article PubMed
44. Braithwaite RS, Meltzer DO, King JT Jr, Leslie D, Roberts MS. What does the value of modern medicine say about the $50,000 per quality-adjusted life-year decision rule? Med Care 2008;46:349-356.Article PubMed
45. Siegel JE, Weinstein MC, Russell LB, Gold MR. Recommendations for reporting cost-effectiveness analyses. Panel on Cost-Effectiveness in Health and Medicine. JAMA 1996;276:1339-1341.Article PubMed
46. Task Force on Principles for Economic Analysis of Health Care Technology. Economic analysis of health care technology. A report on principles. Ann Intern Med 1995;123:61-70.Article PubMed
47. Brown GC. Value-based medicine: the new paradigm. Curr Opin Ophthalmol 2005;16:139-140.Article PubMed
48. Robinson R. Cost-utility analysis. BMJ 1993;307:859-862.Article PubMed PMC
49. O’Connor A. Using patient decision aids to promote evidence-based decision making. ACP J Club 2001;135:A11-A12.Article
50. Bae JM. Academic strategies based on evidence-practice gaps. Hanyang Med Rev 2015;35:3-8 (Korean).Article

Figure & Data

References

Citations

Citations to this article as recorded by

Which social accountability competencies make a good physician? A qualitative investigation of the patient perspective on social accountability
Janique Oudbier, Tobias Boerboom, Saskia Peerdeman, Jeanine Suurmond
Medical Teacher.2024; : 1. CrossRef
Value-based health care in Western countries: a scoping review on the implementation of patient-reported-outcomes sets for hospital-based interventions
Job F.H. Eijsink, Annabel M. Fabian, Johanna P.M. Vervoort, Mohamed N.M.T. Al Khayat, Cornelis Boersma, Maarten J. Postma
Expert Review of Pharmacoeconomics & Outcomes Research.2023; 23(1): 1. CrossRef
Health-related quality of life in various health conditions: two consecutive surveys of older Japanese adults
Takaaki Ikeda, Yoshimune Hiratsuka, Natsuyo Yanagi, Yasunori Komaki, Masayasu Murakami, Jun Aida, Katsunori Kondo, Ken Osaka
Quality of Life Research.2023; 32(4): 1209. CrossRef
Benefit-aware early prediction of health outcomes on multivariate EEG time series
Shubhranshu Shekhar, Dhivya Eswaran, Bryan Hooi, Jonathan Elmer, Christos Faloutsos, Leman Akoglu
Journal of Biomedical Informatics.2023; 139: 104296. CrossRef
Is being able to walk to the letterbox life-changing? A qualitative assessment of measures of improvement in persistent breathlessness
Diana H. Ferreira, Magnus Ekström, Cornelia Verberkt, Daisy J.A. Janssen, David C. Currow
ERJ Open Research.2023; 9(2): 00530-2022. CrossRef
Design considerations for a hierarchical semantic compositional framework for medical natural language understanding
Ricky K. Taira, Anders O. Garlid, William Speier, Ilya Safro
PLOS ONE.2023; 18(3): e0282882. CrossRef
Editorial: From clinical trials to real-world data sciences for value in health: access, utilization, and quality
Xiangxiang Jiang, Gang Lv, Jing Yuan, Kevin Lu
Frontiers in Public Health.2023;[Epub] CrossRef
Centralisation of specialist cancer surgery: an assessment of patient preferences for location of care in the upper South Island of New Zealand
Ahrin Anna Morrow, Andrew McCombie, Fraser Jeffery, Chris Frampton, Todd Hore
ANZ Journal of Surgery.2023; 93(9): 2180. CrossRef
Correlation of preference- and profile-based quality of life of Japanese oral cancer patients during the perioperative period measured using EQ-5D-5L and FACT-H&N
T. Aoki, Y. Ota, K. Izawa, Y. Osawa, S. Seta, B. Tsuda
International Journal of Oral and Maxillofacial Surgery.2022; 51(8): 992. CrossRef
Medical physics 3.0: A renewed model for practicing medical physics in clinical imaging
Ehsan Samei
Physica Medica.2022; 94: 53. CrossRef
How can we optimise health technology assessment and reimbursement decisions to accelerate access to new cardiovascular medicines?
Martin R. Cowie, Biykem Bozkurt, Javed Butler, Andrew Briggs, Maria Kubin, Adrian Jonas, Amanda I. Adler, Bray Patrick-Lake, Faiez Zannad
International Journal of Cardiology.2022; 365: 61. CrossRef
Investigating the feasibility of recruitment to an observational, quality-of-life study of patients diagnosed with atrial fibrillation (AF) who have experienced a bleed while anticoagulated: EQUAL-AF feasibility study protocol
Hayley A. Hutchings, Kirsty Lanyon, Steven Lister, Raza Alikhan, Julian Halcox, Gail Holland, Arfon Hughes, Rhys Jenkins, Hamish Laing, Trudie Lobban, Diane Owen, Kevin G. Pollock, Ceri Todd, Kathie Wareham
Pilot and Feasibility Studies.2022;[Epub] CrossRef
Value-Based Care in Systemic Therapy: The Way Forward
Aju Mathew, Steve Joseph Benny, Jeffrey Mathew Boby, Bhawna Sirohi
Current Oncology.2022; 29(8): 5792. CrossRef
Exploring the measurement of pediatric cognitive-communication disorders in traumatic brain injury research: A scoping review
Lauren Crumlish, Sarah J. Wallace, Anna Copley, Tanya A. Rose
Brain Injury.2022; 36(10-11): 1207. CrossRef
Value-based approach to blood pressure telemonitoring and remote counseling in hypertensive patients
Mikhail V. Ionov, Olga V. Zhukova, Yulia S. Yudina, Natalya G. Avdonina, Igor V. Emelyanov, Dmitri I. Kurapeev, Nadezhda E. Zvartau, Alexandra O. Konradi
Blood Pressure.2021; 30(1): 20. CrossRef
Development of an international standard set of patient-centred outcome measures for overall paediatric health: a consensus process
Beatrix Algurén, Jessily P Ramirez, Matthew Salt, Nick Sillett, Stacie N Myers, Albie Alvarez-Cote, Nancy J Butcher, Luiz F Caneo, Jaime A Cespedes, John E Chaplin, Kee Chong Ng, Juan J García-García, Jan A Hazelzet, Anne F Klassen, Aida Luiza R Turquetto
Archives of Disease in Childhood.2021; 106(9): 868. CrossRef
What matters to patients: Parental and caregiver opinions on International Consortium for Health Outcomes Measurements overall health outcomes for children in Singapore
Moira Suyin Chia, John Yeow Yang Wong, Irene Pheck Mui Chan, Kee Chong Ng
Proceedings of Singapore Healthcare.2021; 30(4): 294. CrossRef
Value-based care in obstetrics: comparison between vaginal birth and caesarean section
Romulo Negrini, Raquel Domingues da Silva Ferreira, Daniela Zaros Guimarães
BMC Pregnancy and Childbirth.2021;[Epub] CrossRef
LIFE QUALITY ASSESSMENT OF PATIENTS WITH STABLE CORONARY ARTERY DISEASE AFTER MYOCARDIAL REVASCULARIZATION
I. A. Narkevich, O. D. Nemyatykh, K. A. Kovaleva, L. G. Ratova, I. O. Trushnikova, E. N. Parizhskaya, A. O. Konradi
Pharmacy & Pharmacology.2021; 8(6): 465. CrossRef
Hypertension specific patient-reported outcome measure. Part III: validation, responsiveness and reliability assessment
M. V. Ionov, N. E. Zvartau, E. A. Dubinina, N. N. Khromov-Borisov, I. A. Tregubenko, A. O. Konradi
Russian Journal of Cardiology.2020; 25(3): 3438. CrossRef
Human Computer Interaction During Clinical Decision Support With Electronic Health Records Improvement
Katerina V. Bolgova, Sergey V. Kovalchuk, Marina A. Balakhontceva, Nadezhda E. Zvartau, Oleg G. Metsker
International Journal of E-Health and Medical Communications.2020; 11(1): 93. CrossRef
Hypertension specific patient-reported outcome measure. Part III: validation, responsiveness and reliability assessment
M. V. Ionov, N. E. Zvartau, E. A. Dubinina, N. N. Khromov-Borisov, I. A. Tregubenko, A. O. Konradi
Russian Journal of Cardiology.2020; 25(3): 109. CrossRef
Sicily Network for Liver Cancer: A Multidisciplinary Network Model for the Management of Primary Liver Tumors
Ciro Celsa, Giuseppe Cabibbo, Duilio Pagano, Vito di Marco, Calogero Cammà, Salvatore Gruttadauria
Journal of Laparoendoscopic & Advanced Surgical Techniques.2020; 30(10): 1048. CrossRef
Coproduction: when users define quality
Glyn Elwyn, Eugene Nelson, Andreas Hager, Amy Price
BMJ Quality & Safety.2020; 29(9): 711. CrossRef
Adjust your own oxygen mask before helping those around you: an autoethnography of participatory research
Abby M. Steketee, Thomas G. Archibald, Samantha M. Harden
Implementation Science.2020;[Epub] CrossRef
Cost-Effectiveness Analysis of Motion-Preserving Operations for Wrist Arthritis
Helene Retrouvey, Beate Sander, Herbert P. von Schroeder, Paul Binhammer, Heather L. Baltzer
Plastic & Reconstructive Surgery.2020; 146(5): 588e. CrossRef
Blood pressure telemonitoring and remote counseling of hypertensive patients: pros and cons
M. V. Ionov, N. E. Zvartau, A. O. Konradi, E. V. Shlyakhto
Russian Journal of Cardiology.2020; 25(10): 4066. CrossRef
Patients and informal caregivers' experience of surgical and transcatheter aortic valve replacement: Real‐world data contributing to establish value‐based medicine in Denmark
Liesbeth Rosseel, Gintautas Bieliauskas, Bente B. Brodersen, Peter S. Olsen, Lars Søndergaard, Ole De Backer
Clinical Cardiology.2019; 42(4): 444. CrossRef
Patients’ early engagement in research proposal development (PEER-PD): patients guiding the proposal writing
Nabil Natafgi, A Tsahai Tafari, Cynthia Chauhan, Justin E Bekelman, C Daniel Mullins
Journal of Comparative Effectiveness Research.2019; 8(6): 441. CrossRef
Les médecines alternatives et complémentaires dans le système Evidence-based medicine. Une étude philosophique de l’ostéopathie
B. Hogedez, N. Gaudreault
Ethics, Medicine and Public Health.2019; 8: 156. CrossRef
Population Health: The Diabetes Educator’s Evolving Role
Teresa L. Pearson, Joan Bardsley, Susan Weiner, Leslie Kolb
The Diabetes Educator.2019; 45(4): 333. CrossRef
Value-based medicine and palliative care: how do they converge?
Simone Garruth Dos Santos Machado Sampaio, Luciana Branco Da Motta, Celia Pereira Caldas
Expert Review of Pharmacoeconomics & Outcomes Research.2019; 19(5): 509. CrossRef
Why physics in medicine?
Ehsan Samei, Thomas M. Grist
Physica Medica.2019; 64: 319. CrossRef
DNA Methylation Cancer Biomarkers: Translation to the Clinic
Warwick J. Locke, Dominic Guanzon, Chenkai Ma, Yi Jin Liew, Konsta R. Duesing, Kim Y.C. Fung, Jason P. Ross
Frontiers in Genetics.2019;[Epub] CrossRef
Personalizing Precision Oncology Clinical Trials in Latin America: An Expert Panel on Challenges and Opportunities
Roberto Jun Arai, Rodrigo Santa Cruz Guindalini, Andrea Sabina Llera, Juan Manoel O'Connor, Bettina Muller, Mauricio Lema, Helano C. Freitas, Tannia Soria, Lucía Delgado, Denis Landaverde, Paola Montenegro, Rachel P. Riechelmann
The Oncologist.2019; 24(8): e709. CrossRef
From Complementary to Integrative Medicine and Health: Do We Need a Change in Nomenclature?
Dieter Melchart
Complementary Medicine Research.2018; 25(2): 76. CrossRef
Why Physics in Medicine?
Ehsan Samei, Thomas M. Grist
Journal of the American College of Radiology.2018; 15(7): 1008. CrossRef
3．Practical Use of QOL/PRO for Health Technology Assessment in Japan
Hideki MURASAWA, Kojiro SHIMOZUMA
Japanese Journal of Pharmacoepidemiology/Yakuzai ekigaku.2018; 23(1): 19. CrossRef
Toward a Consensus on Centralization in Surgery
René Vonlanthen, Peter Lodge, Jeffrey S. Barkun, Olivier Farges, Xavier Rogiers, Kjetil Soreide, Henrik Kehlet, John V. Reynolds, Samuel A. Käser, Peter Naredi, Inne Borel-Rinkes, Sebastiano Biondo, Hugo Pinto-Marques, Michael Gnant, Philippe Nafteux, Mir
Annals of Surgery.2018; 268(5): 712. CrossRef
Electronic Health Records as an Educational Tool: Viewpoint
Yacob Habboush, Robert Hoyt, Sary Beidas
JMIR Medical Education.2018; 4(2): e10306. CrossRef
Formation of requirements for a reference architectural model for the digital transformation of a medical organization
I. V. Ilyin, V. M. Ilyashenko
Scientific bulletin of the Southern Institute of Management.2018; (4): 82. CrossRef
Principialismo, bioética personalista y principios de acción en medicina y en servicios de salud
Jorge Tomas Insua
Persona y Bioética.2018; 22(2): 223. CrossRef
Ethical, pedagogical, socio-political and anthropological implications of quaternary prevention
Marc Jamoulle, Michel Roland, Jong-Myon Bae, Bruno Heleno, Giorgio Visentin, Gustavo Diniz Ferreira Gusso, Maciek Godycki-Ćwirko, Miguel Pizzanell, Patrick Ouvrard, Ricardo La Valle, Luis Filipe Gomes, Daniel Widmer, Jorge Bernstein, Mariana Mariño, Hamil
Revista Brasileira de Medicina de Família e Comunidade.2018; 13(40): 1. CrossRef
Strategies for Derisking Translational Processes for Biomedical Technologies
Mohamed Abou-El-Enein, Georg N. Duda, Elliott A. Gruskin, David W. Grainger
Trends in Biotechnology.2017; 35(2): 100. CrossRef
Strategies for Appropriate Patient-centered Care to Decrease the Nationwide Cost of Cancers in Korea
Jong-Myon Bae
Journal of Preventive Medicine and Public Health.2017; 50(4): 217. CrossRef
Towards evolutionary discovery of typical clinical pathways in electronic health records
Anastasia A. Funkner, Aleksey N. Yakovlev, Sergey V. Kovalchuk
Procedia Computer Science.2017; 119: 234. CrossRef
Improving Electronic Medical Records with Support of Human Computer Interaction in Medical Information Systems
Ekaterina V. Bolgva, Nadezhda E. Zvartau, Sergey V. Kovalchuk, Marina A. Balakhontceva, Oleg G. Metsker
Procedia Computer Science.2017; 121: 469. CrossRef
Data-driven modeling of clinical pathways using electronic health records
Anastasia A. Funkner, Aleksey N. Yakovlev, Sergey V. Kovalchuk
Procedia Computer Science.2017; 121: 835. CrossRef
Integrative Health: Implications from a Report That Medical Errors Are the USA's Third Leading Cause of Death
John Weeks
The Journal of Alternative and Complementary Medicine.2016; 22(7): 493. CrossRef
Development and application of patient decision aids
Jong-Myon Bae
Epidemiology and Health.2015; 37: e2015018. CrossRef
Telepsychiatry: Benefits and costs in a changing health-care environment
Maryann Waugh, Debbie Voyles, Marshall R. Thomas
International Review of Psychiatry.2015; 27(6): 558. CrossRef