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

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. This systematic review followed the Preferred
Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)
guidelines. Data sources include Medline, Embase, Web of Science
CC, and the Cochrane CRCT databases were searched from 1946 to the present
for VBHC strategies and/or components and military settings, including
associated keywords. We included observational and trial studies
focused on the presence of VBHC components and/or systems, and the
presence of acute/trauma operational care or definitive post-operational
care regarding combat-injured service members. The included articles were
classified into injury-related and system-level studies. Two independent
reviewers used standardised methods to search, screen and code included
studies. For quality assessment the mixed methods appraisal tool (MMAT)
Version 2018 was used. 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 (IPU)’ 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. The systematic review showed the application of VBHC
components in military medicine, although the 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 into health outcomes (both clinically- and
patient-reported) and overall quality of care.