In any area of the market, improving business understanding and performance depends on shared objectives that unite the interests and activities of all stakeholders.
In the health sector, however, stakeholders have a multitude of conflicting goals that include access, profitability, technical quality of professionals, quality of care provision offered, cost containment, safety, convenience, patient centralization in care and satisfaction of the patient. The lack of clarity of these objectives brought divergent approaches, games of interests and slow progress in improving the performance of these organizations. Achieving high value for patients should be the main objective, and its definition, based on the health results achieved – considering in addition to the clinical outcome, the relevance of the service provided – in relation to the amount spent.
With rising costs, service restrictions and differences in the quality of health care, there is an increasing need for reform to improve its value. For many, value is still defined as a result of costs.
Value-based health care aims to achieve greater value for patients, ensuring the sustainability of the system through efficient and effective care. It is assumed that this objective is achieved by using the measurement of results by clinical condition, and the consequent identification of the potential for improvement throughout the service cycle. A higher value for patients, measuring results, is one of the possible methods to improve the quality of care in relation to costs spent.
The use of clinical records is considered crucial to systematically measure clinical results, with the aim of obtaining better value for patients. A clinical record is defined as “an organized system that uses observational study methods to collect uniform data (clinical data such as structure, process and outcome measures) to evaluate specified results for a population defined by a disease or clinical condition”.
The health care quality is usually assessed using structure, process, or outcome measures. The latter provides insights into the results of one or more diseases, survival, functional status, and quality of life. The goal of measuring results is diverse; guide clinical decision-making, initiate improvement interventions, benchmarking, monitoring, scientific research and accountability. Measuring results and using them to identify possible improvements contributes to the goal of achieving greater value for patients.
Using a set of patient-relevant outcome measures allows for reliable comparisons and exposes the quality of decision-making and operational processes.