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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Value-Based Health Care &#40;VBH&#41; is a concept introduced by Michael E&#46; Porter in 2006&#46; It means value is a concept that guides health care practice towards activities that generate the best possible health outcomes&#44; and that are relevant to patients&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">But&#8230; Who defines value&#63; In the NEJM&#44; it is defined as the value defined by the patient&#44; not by the service provider&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> And why is it important&#63;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient has become an active agent in their health&#44; making informed shared decisions and taking an increasingly prominent role in their health&#46; We have moved from a paternalistic paradigm in which the clinician decides based on scientific knowledge&#44; to a paradigm in which patients decide by themselves&#44; with information and help from professional training&#44; what is most beneficial for their health in their specific and particular situation within a framework of shared decision-making&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In this new paradigm&#44; considering the patient&#8217;s experience is very relevant and can be very revealing for clinicians&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The Beryl Institute defines patient experience as &#8220;the sum of all interactions&#44; shaped by an organization culture&#44; that influence patient perceptions across the continuum of care&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The continuum of care refers to the entire integrated care process of an illness&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The fragmentation of care processes&#44; specialization&#44; coordination&#44; and transfers among professional services can bring associated hidden difficulties or &#8220;pain points&#8221; that worsen outcomes and value from the patient&#8217;s perspective&#46; Analyzing and understanding these hidden needs can transform and innovate our routine daily practice through co-creation to achieve health outcomes that matter to patients and are more efficient for the system&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The ICU experience impacts patients and families&#46; It is associated with physical&#44; mental&#44; and cognitive sequelae that can persist even after ICU discharge &#40;known as the post-ICU syndrome&#41;&#44; making it necessary to implement prevention and support strategies to mitigate these negative outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Former experiences regarding patient experience at the ICU setting have identified unmet needs such as pain control&#44; discomfort&#44; communication difficulties&#44; insomnia&#44; and post-ICU syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> These experiences are valued negatively by patients and can be potentially preventable and avoidable&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Improving patient experience is thus the result of a collaborative and multidisciplinary discovery process to identify unmet needs of patients related to their care process and illness&#46; These needs may include information&#44; time management&#44; accessibility&#44; the impact of illness on activities of daily life&#44; emotional needs&#44; etc&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The first step would be to understand this need and construct the &#8220;Journey Map&#8221; of the ICU process &#40;see <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; with professionals&#44; to define the people involved in the processes&#44; group patients into archetypes or groups based on specific needs seeking the greatest patient representativeness&#44; and finally explore patient experience in the different groups through qualitative&#47;quantitative methodologies such as focus groups&#44; interviews&#44; and&#47;or surveys&#46; The team should be transdisciplinary to provide different perspectives of the process&#44; with clinical leadership that offers a vision from knowledge&#44; ensures the implementation of improvements&#44; and can provide feedback on results through indicators &#40;PREMS and PROMS&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Concrete actions at the ICU setting such as improving empathy&#44; communication&#44; and information for patients and families at different times and in different formats&#44; addressing emotional needs&#44; managing discomfort triggers&#44; structuring patient transitions from ICU to ward&#44; adapting structures&#44; and even improving the experience of professionals have a clear impact on the patient experience at the ICU setting&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7&#44;8</span></a> Moreover&#44; all these actions can impact results that can be evaluated with indicators like PREMS&#44; which are starting to be quality indicators in ICUs&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">It is obvious that it is necessary&#44; and although it is also fashionable&#8230; it is here to stay&#46; There are different experiences in hospitals that are integrating patient experience into their routine clinical practice&#44; gradually transforming organizations and organizational cultures&#46; Although there are various actions in this regard&#44; what is common is the need for commitment from leadership&#44; management&#44; health care administrations&#44; and the promotion of strategy from clinical leadership&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows factors recently described in an article on suggestions for improving the experience of critically ill patients&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Positive intensive care would attend to physiological needs but also psychological needs and well-being even after ICU discharge&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Simple actions such as incorporating diaries in the ICU &#40;information for patients&#41; not only improve patient outcomes but also their quality of life by filling memory gaps that occur after a prolonged ICU stay&#44; for example&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The issue of coordinating several professionals in one visit to optimize patient time management&#44; or nursing interventions to empower patients at ICU discharge&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion&#44; incorporating patient experience is a way to add value and meaning to our routine daily practice&#44; implementing a lever for change to transform the healthcare system&#44; redesigning processes&#44; incorporating the patient&#8217;s voice to gain value&#44; creating an organizational culture that generates value&#8212;value that translates into results that matter to people&#44; contributing to quality&#44; safety&#44; system efficiency&#44; and sustainability&#46; A correct understanding of patient experience can help improve the ICU experience and outcomes for patients and professionals&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">It&#8217;s not just a trend&#44; but a necessity&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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                  \t\t\t\t">1&#46; Explore aspects of patient experience in the broadest terms&#46;2&#46; Consider patient factors&#44; environmental factors&#44; care&#44; and intervention&#46;3&#46; Assess patient opinions through their representatives&#46;4&#46; Evaluate patient experience early in the post-ICU phase to better recall ICU experiences after excluding delirium&#46;5&#46; Assess patient experience later to detect adverse sequelae &#40;anxiety&#44; depression&#44; post-traumatic stress disorder&#41;&#46;6&#46; Link aspects of patient experience with the quality of care at the ICU setting&#46;&nbsp;\t\t\t\t\t\t\n
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Letter to the Editor
Available online 2 September 2024
Incorporating the perspective of the critically ill patient: A matter of fashion or necessity?
Incorporar la perspectiva del paciente crítico… ¿Cuestión de moda o de necesidad?
Olga Rubio Sanchiza,
Corresponding author
orubio@clinic.cat

Corresponding author.
, Joan Escarrabillb
a Médico Intensivista, Responsable de la Experiencia del Paciente, Hospital Clínic de Barcelona, Spain
b Médico Neumólogo, Observatori XPA, Hospital Clínic de Barcelona, Spain
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Table 1. Patient experience and improvement suggestions.

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