Value and Limitations in Hospital Utilization and Expenditure (VALHUE) – Measuring Surgical and Stroke Outcomes Project Summary
Significance and Policy Context
VALHUE aims to address the gap in knowledge of patient outcomes for surgical and stroke patients. In the surgical context, there is little understanding of whether shorter wait times are associated with better clinical outcomes, and whether policy-linked initiatives to increase access to surgery are associated with consistent changes in health improvement. For stroke patients, there is little understanding of short-term and long-term outcomes once discharged from hospital. VALHUE aims to continually and longitudinally collect patient reported outcomes of surgical and stroke patients to aid quality improvement efforts in British Columbia, Canada.
This study is intended to inform clinicians, VCH decision makers, and policymakers about the nature of relationships between surgical wait times and stroke recovery on the trajectory of change in health status, pain and depression. We expect to continuously provide dada and results that will be immediately relevant in BC and other provinces for implementing changes to prioritizing health expenditures. This study is the first in Canada to a) examine the trajectory of patients’ health while on the wait list, b) differentiate the impact of surgical care by different types of conditions, and c) collect patient reported outcomes of stroke patients in the community. VALHUE is a significant PROMS project within VCH that began in January 2012.
Objective and Specific Aims
This joint project with the University of British Columbia aims to 1) quantify the association between time spent on the surgical waitlist and health status and 2) quantify the change in health status for stroke patients over time. This is to be evaluated by measuring changes in health status for those patients undergoing selected surgical procedures or recently discharged from hospital due to stroke.
The VALHUE project uses validated Patient Reported Outcome instruments to measure change in general health status, acute and chronic pain, and depression.
VALHUE has two specific aims:
- Aim 1: Surveying patients twice prior to surgery, we will test for changes in patients’ health while on the surgical wait list. Surveying patients pre- and post-surgery, we will test for changes in patients’ health because of wait times.
- Aim 2: Surveying stroke patients over the course of 5 years post-hospital discharge, we will test for changes in patients’ health while recovering from stroke.
Methods
This project consists of both a quality assurance component and a research component. VCH is responsible for collecting the survey data for several elective surgical procedures and for stroke as part of a quality assurance project.
Registered patients are contacted regarding their interest in participating and, after obtaining consent, a sequence of surveys are administered to each participant, including: 1) a generic health status questionnaire (EQ-5D), 2) a pain questionnaire (PEG), 3) a depression assessment (PHQ-9), and 4) a condition-specific questionnaire (for different surgery conditions or for stroke). Surgical patients are surveyed soon after being booked on the waitlist registry, approximately two weeks before surgery, and approximately six months after surgery. Stroke patients are surveyed 1-, 6-, 12-, 24-, 36-, 42-, 54-months post-hospital discharge. Survey data will be linked to Discharge Abstract Database (DAD) and NACRS, to include other outcome data, such as discharge disposition, readmissions, time on waitlist, and expected cost. VCH will de-identify the data and transfer it to UBC for research and analysis purposes.
While we will take every effort to minimize participant drop-out, some participants will not complete all surveys and some data will be missing (incomplete). We will adjust the models for missing data when required. Although the instruments are previously validated, we will also examine the data to detect whether the data are affected by “floor” or “ceiling” effects.
Products
For VCH, regular analytical reports will be generated which provide a comprehensive profile of patients’ health status, pain and depression while waiting for surgery. These timely reports will be shared with Vancouver Coastal Health and Providence Health Care sites via Decision Support.
For UBC researchers, and for the community at large, this study will provide insight into how patients’ health changes while waiting for surgery or recovering from stroke. In addition, the study will collect valuable information, and report on, changes in health attributable to surgery or stroke. It is expected that researchers and clinical collaborators will use the results to help guide quality improvement initiatives and produce manuscripts for academic publications.
Contact:
Jason Sutherland
Principal Investigator, UBC
jason.sutherland@ubc.ca
Kate Redfern
Project Manager, VCH
kate.redfern@vch.ca