Value-based healthcare from a military health system perspective: a systematic review

Abstract

Objectives The aim of this systematic review was to provide an overview of value-based healthcare (VBHC) strategies and/or components within military medicine. For this purpose, the extent to which VBHC has been applied within a military health system (MHS), with emphasis on military trauma care was assessed.Design This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sources Medline, Embase, Web of Science CC and the Cochrane CRCT databases were searched from 1946 to present for VBHC strategies and/or components and military settings, including associated keywords.Eligibility criteria for selecting studies We included observational and trial studies focused on the presence of VBHC components and/or system, and the presence of acute/trauma operational care or definitive postoperational care regarding combat injured service members. The included articles were classified into injury-related and system-level studies.Data extraction and synthesis Two independent reviewers used standardised methods to search, screen and code included studies. For quality assessment, the Mixed Methods Appraisal Tool version 2018 was used.Results A total of 3241 publications were screened, and 18 were included for data extraction. 15 studies focused on (military) medical trauma-related conditions (injury groups), and 3 studies focused on an MHS approach. Four articles contained the two VBHC components (‘creating an integrated practice unit’ and ‘measuring outcomes and costs for every patient’) considered the basis for successful implementation. The ‘outcomes and costs’ and ‘patient-centred care’ components were most prevalent as respectively mentioned in 17 and 8 included studies.Conclusion The systematic review showed the application of VBHC components in military medicine, although use of standard VBHC terminology is not consistently applied. This study suggests that implementing VBHC as a concept in military healthcare, could enhance benchmarking to provide insight in health outcomes (both clinically and patient-reported), and overall quality of care.