[Optimization of the work of outpatient memory clinics from the perspective of value-based healthcare-An approach from the Clinic for Psychiatry and Psychotherapy of the ZI Mannheim].

BACKGROUND

Value-based healthcare (VBHC) is a concept in health economics that aims to improve patient care through needs-oriented treatment approaches while considering the costs incurred. "Value" describes the ratio of patient-centered outcome and experience data to the costs incurred.

OBJECTIVE

To analyze and optimize the workflows of the Outpatient Memory Clinic of the ZI Mannheim according to VBHC criteria. The aim of the study was to improve the quality of care from the patient's perspective, to measure the changes in benefits for all involved parties and simultaneously to evaluate the costs and revenues of the diagnostic process.

METHODS

The initial diagnostic process was analyzed in 25 dyads (patient + caregiver) using standardized (State-Trait Anxiety Inventory (STAI), Patient Assessment of Chronic Illness Care (PACIC), Euroquol visual analogue scale (EQ-VAS)) and process-oriented questionnaires. After staff training, a modified diagnostic process (VBHC-M) was implemented in a pilot study. This process was then evaluated in a second survey of 17 dyads and 8 additional patients using the same questionnaires. The results from both surveys were compared using t‑tests or Mann-Whitney U tests. A cost and revenue analysis (CRA) was conducted using annual data.

RESULTS

The quality of care (PACIC) for patients (p < 0.001) and caregivers (p = 0.004) improved following VBHC‑M, as did patient satisfaction and expectations (process-oriented questionnaires). The CRA showed that VBHC‑M resulted in a financial disadvantage for the care provider.

CONCLUSION

The workflows of the outpatient memory clinic could be successfully optimized in the sense of patient-centered care, leading to an increased number of patients treated, higher patient and caregiver satisfaction and cost savings. This shows that VBHC can be implemented in outpatient memory clinics; however, the accelerated diagnostic process is reimbursed at a lower rate under the current flat-rate quarterly payment system, highlighting the need for adjustments to reimbursement models.