{"id":1,"date":"2019-02-05T01:38:14","date_gmt":"2019-02-05T01:38:14","guid":{"rendered":"https:\/\/www.precisionostech.com\/?p=1"},"modified":"2019-11-06T15:06:31","modified_gmt":"2019-11-06T15:06:31","slug":"the-virtuous-circle-of-value-for-surgeons","status":"publish","type":"post","link":"https:\/\/www.precisionostech.com\/de\/the-virtuous-circle-of-value-for-surgeons\/","title":{"rendered":"Der tugendhafte Wertezirkel f\u00fcr Chirurgen"},"content":{"rendered":"<p>Michael Porter ist der Meinung, dass sich das Gesundheitssystem in ein System verwandelt, das auf Wert statt auf Dienstleistungen basiert.<br><\/p>\n\n\n\n<p>Auf dem Klinischen Kongress 2018 hat er&nbsp;<a href=\"https:\/\/www.facs.org\/clincon2018\/resources\/highlights\/wed\/nl10\">dr\u00e4ngte die Teilnehmer<\/a>&nbsp;to \u201cbe leaders in this transformation, rather than be dragged along.\u201d He believes such a transformation is necessary because healthcare costs are unsustainable: they\u2019re rising faster than GDP and income in most developed countries.<br><\/p>\n\n\n\n<p>Wie k\u00f6nnen also die Gesundheitskosten gesenkt werden? Porter stellt fest, dass inkrementelle Verbesserungen zur Kostensenkung nicht erfolgreich waren. Stattdessen pl\u00e4diert er f\u00fcr eine Umstrukturierung des Gesundheitswesens hin zu einem einzigen Ziel:&nbsp;<strong>Wertsteigerung f\u00fcr Patienten<\/strong>.<br><\/p>\n\n\n\n<p><a href=\"https:\/\/www.precisionostech.com\/de\/\">Pr\u00e4zisions-Betriebssystem<\/a>&nbsp;partner, Jon \u201cJ.P.\u201d Warner M.D., believes healthcare providers should learn from Porter\u2019s&nbsp;<strong>Tugendhafter Wertekreis<\/strong>, die die Bedeutung des Volumens unterstreicht: Eine h\u00f6here Anzahl von Patienten mit der gleichen Erkrankung erm\u00f6glicht einen h\u00f6heren Nutzen f\u00fcr die Patienten.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Volumen, Ergebnisse und Wert<\/h2>\n\n\n\n<p>Dr. Warner ist orthop\u00e4discher Chirurg an der&nbsp;<a href=\"http:\/\/bostonshoulderinstitute.com\/\">Boston Shoulder Institute<\/a>&nbsp;und Co-Autor eines im Arthroskopie Journal ver\u00f6ffentlichten Artikels zur Untersuchung der&nbsp;<a href=\"https:\/\/www.arthroscopyjournal.org\/article\/S0749-8063(17)30286-4\/pdf\">Beziehung zwischen Volumen und Ergebnissen<\/a>&nbsp;im chirurgischen Bereich.<br><\/p>\n\n\n\n<p>Er weist darauf hin, dass Untersuchungen zeigen, dass Anbieter mit geringem Volumen mit l\u00e4ngeren Krankenhausaufenthalten, l\u00e4ngeren OP-Zeiten, erh\u00f6hten Krankenhauskomplikationen und h\u00f6heren Kosten verbunden sind. Er stellt jedoch auch fest, dass der Einfluss des Volumens auf die Ergebnisse in F\u00e4llen geringer ist, in denen eine orthop\u00e4dische Facharztausbildung eine gr\u00f6\u00dfere Exposition bietet (wie beispielsweise bei der totalen H\u00fcft- und Knieendoprothetik).<br><\/p>\n\n\n\n<p>Diese Ergebnisse legen nahe, dass die Festlegung eines Volumenschwellenwerts eine M\u00f6glichkeit ist, den Patienten einen besseren Wert zu bieten. Porter war der erste, der die&nbsp;<strong>Wertegleichung f\u00fcr effektive Pflege<\/strong>:<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><em>Wert = Ergebnis\/Kosten<\/em><br><\/h2>\n\n\n\n<p>Um den Patienten mehr Wert zu bieten, m\u00fcssen Gesundheitsdienstleister entweder die chirurgischen Ergebnisse verbessern oder die Kosten senken. Porter hat das studiert&nbsp;<a href=\"http:\/\/refhub.elsevier.com\/S0749-8063(17)30286-4\/sref8\">Wirkung des Operationsvolumens<\/a>&nbsp;on outcomes and value in healthcare and proposed a \u201cVirtuous Circle of Value\u201d based on the volume of care (see figure below).<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" width=\"499\" height=\"499\" data-src=\"https:\/\/www.precisionostech.com\/wp-content\/uploads\/2019\/02\/Virtuous-Circle-of-Value.png\" alt=\"\" class=\"wp-image-203 lazyload\" data-srcset=\"https:\/\/www.precisionostech.com\/wp-content\/uploads\/2019\/02\/Virtuous-Circle-of-Value.png 499w, https:\/\/www.precisionostech.com\/wp-content\/uploads\/2019\/02\/Virtuous-Circle-of-Value-300x300.png 300w, https:\/\/www.precisionostech.com\/wp-content\/uploads\/2019\/02\/Virtuous-Circle-of-Value-150x150.png 150w, https:\/\/www.precisionostech.com\/wp-content\/uploads\/2019\/02\/Virtuous-Circle-of-Value-12x12.png 12w\" data-sizes=\"(max-width: 499px) 100vw, 499px\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" style=\"--smush-placeholder-width: 499px; --smush-placeholder-aspect-ratio: 499\/499;\" \/><\/figure>\n\n\n\n<p><strong><em>Quelle<\/em><\/strong><em>:&nbsp;<\/em><a href=\"https:\/\/www.arthroscopyjournal.org\/article\/S0749-8063(17)30286-4\/pdf\"><em>Volumen und Ergebnis: 100 Jahre Wertperspektive von EA Codman bis ME Porter<\/em><\/a><em>, reprinted from Porter and Kaplan\u2019s \u201cHow to pay for healthcare\u201d.<\/em><br><\/p>\n\n\n\n<p>Ein gr\u00f6\u00dferes Patientenvolumen f\u00fchrt zu einer positiven Feedbackschleife von Verbesserungen, beginnend mit mehr Erfahrung, besseren Daten, steigender Effizienz usw.<br><\/p>\n\n\n\n<p>It\u2019s important to note, however, that providers can begin at multiple points in the cycle: increasing volume is not the only way to increase value. Dr. Warner shows that&nbsp;<strong>systematische Bem\u00fchungen, Ergebnisse zu messen und zu verbessern<\/strong>&nbsp;kann auch zu besseren Ergebnissen f\u00fchren.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Die Bedeutung der Messung von Ergebnissen<\/h2>\n\n\n\n<p>Porter bietet die&nbsp;<a href=\"https:\/\/www.martini-klinik.de\/en\/for-patients\/\">Martini-Klinik<\/a>&nbsp;in Deutschland als Beispiel f\u00fcr einen Gesundheitsdienstleister, der den Virtuous Circle of Value verinnerlicht hat.<br><\/p>\n\n\n\n<p>They created \u201ca hospital within a hospital\u201d that integrates all the elements of care and, most crucially, supports the systematic measurement of outcomes to determine which surgeons are underperforming. When an underperformer at the Martini Klinik is identified, they receive mentorship from better-performing surgeons. As a result, outcomes quickly improve up to the required benchmark.<br><\/p>\n\n\n\n<p>Insgesamt weist die Martini Klinik deutlich geringere Komplikationsraten auf als vergleichbare Anbieter. Daher kann das Volumen wichtig sein, aber auch die systematische Messung der Ergebnisse.&nbsp;<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0003497516307469\">Forschung durchgef\u00fchrt von Dr. Shahian<\/a>&nbsp;best\u00e4tigt, dass die Messung des gesamten Behandlungsprozesses, von der pr\u00e4operativen Entscheidungsfindung bis zur Operation und Nachsorge, die Ergebnisse dramatisch verbessern kann. EA Codman w\u00fcrde dem zustimmen.<br><\/p>\n\n\n\n<p>In&nbsp;<a href=\"https:\/\/books.google.ca\/books?id=5d8MtAEACAAJ&amp;dq=hospital+efficiency+codman&amp;hl=en&amp;sa=X&amp;redir_esc=y\"><em>Krankenhauseffizienz<\/em><\/a>, Codman schrieb:<br><\/p>\n\n\n\n<p>\u201cTo effect improvement, the first step is to admit and record the lack of perfection. The next step is to analyze the causes of failure and to determine whether these causes are controllable.\u201d<br><\/p>\n\n\n\n<p>Dr. Warner kommt zu dem Schluss, dass, obwohl das Volumen eine Rolle bei der Bestimmung des Werts spielt, die Messung von Ergebnissen und Verbesserungen auf der Grundlage dieser Messungen noch wichtiger ist.<br><\/p>\n\n\n\n<p>Dr. Warner believes measuring outcomes will become even more important as hospitals move to alternative payment models \u2013 and there have already been proposals for the creation of insurance bundles in shoulder arthroplasty and rotator cuff repair. For example, in 1994, Johnson and Becker proposed and delivered a warranty on outcomes for a&nbsp;<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0749806305802002\">zweij\u00e4hrige Pilotstudie zur Arthroskopie<\/a>&nbsp;und gelang es, die Gewinnspannen f\u00fcr das Krankenhaus und den betroffenen Chirurgen zu erh\u00f6hen.<br><\/p>\n\n\n\n<p>Es hat sich gezeigt, dass der Fokus auf die Verbesserung der Ergebnisse statt auf die Bereitstellung von Dienstleistungen ein solider Weg ist, um Kosten zu senken und den Wert f\u00fcr die Patienten zu steigern.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Wert und Ergebnisse<\/h2>\n\n\n\n<p>Es besteht ein klarer Zusammenhang zwischen Volumen und Ergebnissen (wie im Virtuous Circle of Value gezeigt). Gesundheitsdienstleister k\u00f6nnen jedoch auch den Patientenwert durch einen speziellen Ansatz f\u00fcr Messung, Aufsicht und praktisches Lernen und Mentoring-Programme steigern.<br><\/p>\n\n\n\n<p>Zur\u00fcck zum Virtuous Circle of Value: Der Prozess der Messung und Verbesserung der Ergebnisse steigert auf nat\u00fcrliche Weise die Effizienz, verbessert die chirurgischen Ergebnisse und erh\u00f6ht den Wert f\u00fcr die Patienten. Infolgedessen steigen die Patientenzahlen und Chirurgen und Krankenh\u00e4user sehen mehr Gewinn.<br><\/p>\n\n\n\n<p>Gesundheitsdienstleister k\u00f6nnen daher den Wert f\u00fcr alle steigern, indem sie einen Prozess des kontinuierlichen Lernens und der Verbesserung einf\u00fchren.<\/p>","protected":false},"excerpt":{"rendered":"<p>Michael Porter thinks the healthcare system is transforming into a system based on value rather than services. At Clinical Congress 2018, he&nbsp;urged attendees&nbsp;to \u201cbe leaders in this transformation, rather than be dragged along.\u201d He believes such a transformation is necessary because healthcare costs are unsustainable: they\u2019re rising faster than GDP and income in most developed&#8230;<\/p>","protected":false},"author":3,"featured_media":202,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"content-type":"","om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[19],"tags":[],"class_list":["post-1","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-surgery"],"aioseo_notices":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>The Virtuous Circle of Value for Surgeons | PrecisionOS<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.precisionostech.com\/de\/the-virtuous-circle-of-value-for-surgeons\/\" \/>\n<meta property=\"og:locale\" content=\"de_DE\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The Virtuous Circle of Value for Surgeons | PrecisionOS\" \/>\n<meta property=\"og:description\" content=\"Michael Porter thinks the healthcare system is transforming into a system based on value rather than services. 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