Patient and Family Experience in the Healthcare Value Equation

As outlined in the 2001 Institute of Medicine landmark paper “Crossing the Quality Chasm,” the overarching goal of healthcare is to provide safe, efficient, effective, equitable, timely, and patient-centered care (Crossing the Quality Chasm: A New Health System for the 21st Century, 2001). In addition to these six aims, the cost of care must also be considered and VALUE, our ability to achieve these aims at an affordable cost, is at the forefront of discussions across the nation. VALUE is often defined in terms of the equation: VALUE = QUALITY/COST. This definition prompts important questions about the meaning of quality and cost in healthcare. Traditionally, VALUE in medicine highlights quantitative metrics of quality such as access to services, patient safety measures, preventable conditions, peri-operative complications, re-admissions, resource utilization, and mortality. Metrics such as these are OUTCOMES that define the QUALITY of the care provided. When QUALITY is assessed, patient and family experience measures are often viewed as secondary to clinical outcome measures and relegated to a minor role or excluded all together from the value equation. We assert that in the current medical landscape, the role of patient and family experience should be considered paramount in delivering the best quality, outcomes, and safety at the lowest cost and, therefore, providing the greatest VALUE for the consumer. As such, any discussion of VALUE should include patient and family experience in the equation:VALUE=QUALITYExperience+ClinicalOutcomes+Safety/COST\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$ \mathrm{VALUE} = \mathrm{QUALITY}\ \left(\mathrm{Experience} + \mathrm{Clinical}\ \mathrm{Outcomes} + \mathrm{Safety}\right)/\mathrm{COST} $$\end{document}