Value-based healthcare' (VBHC) and the End Result System

 The idea of 'value-based healthcare' (VBHC) isn't entirely new. The concept of evidence-based quality improvement goes back to the 1850s with Florence Nightingale and her collaboration with the medical statistician William Farr (E.C. Kudzma, 2006).

In medicine, a result- or outcome driven approach goes back to the 'End Result System' of Ernest A. Codman and his article on 'A Study in Hospital Efficiency: As Demonstrated by the Case Report of the First Five Years of a Private Hospital' (1914), in which he stated: "Every hospital should follow every patient it treated to determine whether the treatment has been succesfull for this patient, and should inquire - if not - why not - with the view to prevent similar failure in the future" (E.A. Codman, 2013).

Codman put forward three core principles of quality assurance (QA):

  1. Examining quality measures to determine if problems are patient-, system-, or clinician-related
  2. Assessing the frequency and prevalence of quality deficiencies
  3. Evaluating and correcting deficiencies so that they do not reoccur.

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