Value Based Healthcare in Psoriasis

Background information: Psoriasis is a complex, multi-morbid chronic and systemic disease with a prevalence of 3% in our region. Intuitively, we have been well aware that psoriasis has to be looked at using a holistic approach, taking into account comorbidities as well as psychosocial problems that are linked to the condition. Nine years ago, we decided to set up an integrated practice unit called PsoPlus. Realising that the VBHC framework was very much in line with our approach, we got intrigued by the framework, followed Green Belt tracks and kicked off our PsoPlus research project that is presented here.

Aim and relevance of the initiative: What sets PsoPlus apart from many other initiatives is its research and data driven nature. We put a lot of effort into making a rigorous setup by operationalising the value-pillars. During the execution of the study, we monitor the process by measuring all data concerning outcomes and costs.

Patient description & involvement: Psoriasis patients attending the PsoPlus IPU will be included in the comparator trial, as well as be involved in the development of the COS.

Methods: As there is no COS available for clinical use in psoriasis, development of the COS is our first step, which will be done through a mixed method approach. A systematic review will be done to obtain all patient relevant outcomes in the literature, which will thereafter be ranked by psoriasis patients. Thereafter, the COS will be used in a comparator trial to assess the outcomes achieved in our IPU (PsoPlus) and two standard care centres. Cost will also be measured over the full cycle of care and, combined with the outcomes, will be used in order to define Value.
Size & scope: Our aim is to include in the VBHC track all psoriasis patients that come to UZ Gent. We increased our capacity to a weekly total of 45 patients, in order to be able to service a substantial proportion of psoriasis patients in the region.

(preliminary) results: The systematic review has been completed and is currently submitted for publication. The patient survey regarding COS has started and is nearing its inclusion target (n=120).

Formation of IPUs / collaborations / partnerships:
We aim to set up an integrated practice unit by screening and coordinating care for the 13 most important comorbidities. Screening and referral guidelines are implemented for all these diseases.

Most importantly, we have set up direct access to the rheumatologist and gastro-enterologist. In case of psychosocial issues, we plan a consultation for the patient with the dedicated psychologist. We structured communication with the general practitioner, supported by to-the-point information about the patient’s comorbidities implying treatment of the associated conditions.
Lifestyle behaviour is discussed with every patient and we refer patients to a dietician, obesity clinic and/or services to assist in addiction management (alcohol/smoking) if necessary.

The IPU is currently being updated based on current literature and practices, as well as on the study we performed regarding psoriasis cost drivers.
We are also setting up a DCS. We are working on extending its function, aiding the physician’s clinical decision making.

In terms of collaborations, we work with Vlerick Business school for the development of our costing model. For our data capturing system development, we cooperate with UZ Gent’s IT department.