Outcomes Research, health care delivery and technology assessment.

Chronic liver diseases (CLD) impose a major health burden worldwide affecting the health and lives of many individuals and families as well as substantial costs for individuals and payers. Hepatologists practice a high intensity cognitive sub-specialty,

using complex and costly procedures and medications. High value care requires multi-disciplinary coordination, labor-intensive support for critically ill patients and effective chronic disease management. Under the current system however, patient values, medical success and financial success all can be misaligned. Attempts to link health outcomes to reimbursement continue to be based on compliance with process measures with less emphasis on measures of outcomes that matter most to patients and slow transformation to higher-value team-based care. Outcome indicators (OIs) that reflect the entire cycle of care are needed to assist both clinicians and administrators in improving quality and value of care. A comprehensive set of OIs for liver diseases is not currently available. The Value-based Medicine in Hepatology (VBMH) movement aims to fill this gap, devising and testing a set of outcome indicators for major liver conditions. Recently, a comprehensive set of OIs designed to sequentially capture clinical outcomes at different stages of the natural history of CLDs has been generated and tested. These indicators are a tool to implement a value-based approach for patients with CLDs, to compare results and value of care between referral centers, to perform health technology assessment and to guide decision-making processes for health authorities. The lab is also interested in health care technology assessment in the field of liver cancer treatment.