Developing process measures in value-based healthcare: the case of aortic valve disease

BACKGROUND: As process measures can be means to change practices, this article presents process measures that impact on outcome measures for surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) within value-based healthcare. METHODS: Desk research and observations of patient trajectories were performed to map the processes involved in TAVR and SAVR. Semistructured interviews were conducted with healthcare professionals (n=8) and patients (n=2) to explore which processes were most important in relation to a standard set of outcome measures that was already monitored. Additionally, open interviews (n=2) were held to prioritise results. A focus group was performed for validation of the formulated process measures. Numerical data for these measures was not collected. RESULTS: Process maps of the full cycle of care of TAVR and SAVR treatments in theory and in practice were developed. 28 processes were found important by interview participants due to their expected impact on patient-relevant outcomes. Seven processes were prioritised to be most important and were formulated into 12 process measures for both TAVR and SAVR: ‘Number of times that deficient information provision to SAVR patients causes negative outcomes’, ‘Type of TAVR/SAVR prosthesis’, ‘Brand of TAVR prosthesis’, ‘Number of times the frailty score of a TAVR/SAVR patient >75 years is measured’, ‘Time between TAVR/SAVR surgery indication and surgery’, ‘Number of times that anticoagulants are stopped within 3 days before surgery’, ‘Time in hours between TAVR/SAVR surgery and permanent pacemaker implantation’ and ‘Percentage of standardised pain measurements’. CONCLUSION: This study proposes an addition of select process measures to standard sets of outcome measures to improve healthcare quality. It illustrates a clear method for identifying process measures with impact on health outcomes in the future.