Value in modular healthcare service delivery process - case type 1 diabetes care

Abstract

Recently, the increasing costs have raised interest towards the efficiency and effectiveness of healthcare processes. To capture both the cost and process perspectives, the objective of this study is to address the relationship between the care process and the value created. Instead of episodic treatment, this study focuses on the process of chronic type 1 diabetes care due to its lifelong, repeatable care process which offers a fruitful source of insight to modularity study and the value creation in chronic diseases.

Framework developed for this study is formed based on literature review on service modularity and value-based healthcare. The modularity of healthcare services is discussed from process perspective and the architecture of the process is decomposed into modules. Further the customization and personalization of the process is considered as the configuration of the overall service modules. The performance of the process is grounded on the value-based perspective and evaluated as value created in the care process. Value itself is understood as the equation of outcomes and costs created.

This study is a qualitative single case study on the type 1 diabetes care process. The data of this study is gathered through semi-structured interviews conducted in a newly found Diabetes clinic in Pori that offers vast variety of professional services to type 1 diabetics in public primary healthcare. In addition, the Diabetes clinic succeeds in gathering various professionals under the same clinic.

The results of this study show that the type 1 diabetes care process can be characterized as modular when considering the supporting services provided for the self-treatment. The architecture of the process can be characterized as medium coupled as both the patient and care professionals are present in the formulation of the individual care process and some pre-specified rules of module occurrence are followed. The customization of the care is an ongoing process as the care is planned and customized during every visit to the care professionals. Also, personalization is greatly present in the care process.

The value of the process cannot explicitly be disclosed as the outcomes and costs created could not be fully understood in the process level nor at the module level. The measures used for the outcomes were evaluated based on three-tier model and degree of health and sustainability of the health measures could be identified. However, to fully understand the value created per patient and enable the result comparison between different actors, more universal and comprehensive measures from patient perspective should be used for both outcome and cost measures.