Value-based pre-operative assessment in a large academic hospital

Background: Value-based healthcare (VBHC) aims to improve healthcare by increasing value outcomes. Our study evaluated whether personalised preoperative evaluation based on VBHC principles improves care and outcomes, thus reducing costs. Methods: We conducted a quality improvement before-and-after study to determine the impact of VBHC on preoperative evaluation clinics in Humanitas Research Hospital. The intervention was the implementation of a VBHC-tailored risk matrix during the postintervention phase (year 2021), and the results were compared with those of the preinterventionphase (2019). The primary study outcome was the difference in the number of preoperative tests and visits per patient at baseline and after the intervention. Results: A total of 9,722 patients were included: 5,242 for 2019 and 4,480 for 2021. The median age of the population was 63 (IQR: 51-72), 23% of patients were ASA 3 and 4, and 26.8% (2,955 cases) were day surgery cases. We found a considerable decrease in the number of preoperative tests ordered for each patient after the intervention [6.2 (2.5) vs 5.3 (2.6) tests, p <0.001]. The number of preoperative chest X-ray, electrocardiogram, and cardiac exams decreased significantly. The length of the preoperative course was significantly shorter after the intervention [373 (136) vs 290 (157) minutes, p<0.001]. Cost analysis demonstrated a significant reduction in costs, while there was no difference in clinical outcomes. Conclusions: We demonstrated the feasibility, safety, and cost-effectiveness of a personalized approach to preoperative evaluation. The implementation of VBHC notably enhanced patient care value, as evidenced by decreased patient time in preoperative evaluation and by a reduction in unnecessary preoperative tests.