Tackling the Frailty Burden with an Integravity Value-Based Approach: Results from a Mixed-Methods Study

Daniel Fürstenau*, Hannah Haneke, Claudia Spies, Tim Walz, Kai Schewina, Moritz Höft, Rudolf Mörgeli, Felix Balzer

*Corresponding author for this work

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The purpose of this paper is to investigate the implementation of value-based care principles in the context of frailty in the perioperative process, highlighting the importance of an integrative perspective considering medical and patient-centric outcomes as well as costs.

Subject and methods
This mixed-methods study employs a sequential design. Qualitative observational data were used to identify needs and barriers for implementing value-based principles, and quantitative methods were subsequently used to demonstrate the value of employing such an approach using data gathered from n = 952 patients. Propensity score matching was applied to identify the frailty-associated costs of the inpatient setting for n = 381 non-frail and n = 381 (pre-)frail patients, in particular considering patient-centric outcomes.

The qualitative analysis identified three main challenges when implementing value-based principles in the context of perioperative care and frailty, namely challenges related to the cost, patient-centric, and integrative perspectives. In addressing these shortcomings, a quantitative analysis of a propensity score-matched sample of patients undergoing surgery shows additional frailty-associated costs of 3583.01 [1654.92; 5511.04] EUR for (pre-)frail patients and the influence of individual patient-centric attributes. Effect size Cohen’s d was 0.26.

The results demonstrate that frailty should be considered from an integrative perspective, taking cost, patient-centered outcomes, and medical outcomes into account simultaneously. The results also show the value of a research design which uses qualitative data for the identification of needs and barriers, as well as quantitative data for demonstrating the usefulness of the conceived value-based approach to perioperative care delivery.
Original languageEnglish
JournalJournal of Public Health: From Theory to Practice
Issue number1
Pages (from-to)99-110
Number of pages12
Publication statusPublished - Jan 2022

Bibliographical note

Published online: 17 September 2021


  • Frailty
  • Value-based health care
  • Digital health solutions
  • Barriers
  • Perioperative process
  • Integrative apporach

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