Netherlands Heart Network
Due to the aging of Dutch inhabitants, the expected rise of cardiovascular diseases1, and the associated growth of healthcare costs2-5, initiatives are needed that embrace and implement the promising theory of Value Based Healthcare (VBHC) to offer the most relevant patient outcomes at the lowest costs. Hence, the Netherlands Heart Network (NHN) is initiated and is the first successful implementation of an integrated care delivery system6 that targets patient relevant outcomes for cardiac patients, in a densely populated region in the Netherlands (approximately 756.615 inhabitants7). In essence, the NHN is a joint effort of all relevant healthcare providers in primary, secondary, and tertiary care (i.e. cardiologists, GPs, nurses, ambulance service, thrombosis service, home care organizations, pharmacists, and diagnostic centers) to improve the outcomes that matter most for cardiac patients by organizing the total care delivery value chain in an optimal and uniform way8. Additionally, the most relevant patient outcomes are delivered at the lowest costs in the NHN. In order to achieve the highest patient value the NHN initiates networks concerning specific heart conditions (e.g. atrial fibrillation, heart failure, and coronary artery disease). Within the networks patient relevant outcome measures are indicated using Meetbaar Beter – winner of the VBHC prize 2014 – as a primary source. Due to the close collaboration between Meetbaar Beter and ICHOM, the used set of patient relevant outcome measures are aligned with ICHOM. To ensure the highest value for cardiac patients in the NHN, patient relevant outcome indicators are continuously measured and improved.
To be able to improve outcomes, in every network of the NHN an uniform standard of care is developed (consisting of an uniform definition of the syndrome, initial conditions, patient relevant outcome measures, a process of care, protocols for the specific heart condition, process measures, and structure measures). In this phase the healthcare process is optimized with a focus on improving patient relevant outcomes, the design of the process is led by the strongest hypothesis regarding the added value of all activities in the process to the outcomes. In addition, healthcare costs are saved by eliminating duplication of procedures and tuning transmission of activities between primary, secondary, and tertiary care. By using this approach all conditions of Professor Porters’ Measurement Landscape9 are included. Based on insight in the results of patient relevant outcome measures in the total care delivery chain, the NHN is able to improve the uniform standard of care in order to (continuously) optimize outcomes that matter most to cardiac patients. Due to the continuous improvement also the healthcare costs are (constantly) reduced.
Although the NHN was initiated in 2016, enormous progress has been made in the total care delivery chain due to the large support among doctors regarding the patient centered approach and the focus on improving outcomes that matter most for cardiac patients. This has resulted in a finalized uniform standard of care of the atrial fibrillation network (AF-network) that is implemented in the participating healthcare organizations (i.e. hospitals and GP practices). The development of the uniform standard of care in the heart failure network (HF-network) and coronary artery disease network (CAD-network) are in progress. The expectation is that the HF-network will be finalized by July 2017 and the CAD-network by October 2017. After completion, the patient relevant outcomes are leading in the NHN. Based on insight in outcomes the uniform standard of care is optimized and re-implemented. In this manner, the NHN is able to continuously offer the highest value for cardiac patients.
Up to now, in the AF-network over 460 atrial fibrillation patients (mean age= 68 years; 57,4% is male) have consulted the outpatient clinics of the participating hospitals.
The first results based on the patient relevant outcome measures in the AF-network are expected in May 2017. Subsequently, the quality cycle to improve the most relevant outcomes and reduce the costs of the provided care will start. Due to the progress and high expectations, the Dutch Society for Cardiology has certified the AF-network and CAD-network of the NHN. The certification of the HF-network is planned for July 2017.