title: Value Driven Outcomes (VDO): a pragmatic, modular, and extensible software framework for understanding and improving health care costs and outcomes.
abstract: OBJECTIVE
  To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes).
  
  
  METHODS
  In 2012, a multidisciplinary team was assembled by the leadership of the University of Utah Health Sciences Center and charged with rapidly developing a pragmatic and actionable analytics framework for understanding and enhancing healthcare value. Based on an analysis of relevant prior work, a value analytics framework known as Value Driven Outcomes (VDO) was developed using an agile methodology. Evaluation consisted of measurement against project objectives, including implementation timeliness, system performance, completeness, accuracy, extensibility, adoption, satisfaction, and the ability to support value improvement.
  
  
  RESULTS
  A modular, extensible framework was developed to allocate clinical care costs to individual patient encounters. For example, labor costs in a hospital unit are allocated to patients based on the hours they spent in the unit; actual medication acquisition costs are allocated to patients based on utilization; and radiology costs are allocated based on the minutes required for study performance. Relevant process and outcome measures are also available. A visualization layer facilitates the identification of value improvement opportunities, such as high-volume, high-cost case types with high variability in costs across providers. Initial implementation was completed within 6 months, and all project objectives were fulfilled. The framework has been improved iteratively and is now a foundational tool for delivering high-value care.
  
  
  CONCLUSIONS
  The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value.
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Kensaku
authors.initials: K
authors.lastname: Kawamoto
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Cary J
authors.initials: CJ
authors.lastname: Martin
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Kip
authors.initials: K
authors.lastname: Williams
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Ming-Chieh
authors.initials: MC
authors.lastname: Tu
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Charlton G
authors.initials: CG
authors.lastname: Park
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Cheri
authors.initials: C
authors.lastname: Hunter
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Staes
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Bray
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Vikrant G
authors.initials: VG
authors.lastname: Deshmukh
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Reid A
authors.initials: RA
authors.lastname: Holbrook
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Morris
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Fedderson
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Sletta
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: James
authors.initials: J
authors.lastname: Turnbull
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Sean J
authors.initials: SJ
authors.lastname: Mulvihill
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Gordon L
authors.initials: GL
authors.lastname: Crabtree
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Entwistle
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Quinn L
authors.initials: QL
authors.lastname: McKenna
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Strong
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Pendleton
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Vivian S
authors.initials: VS
authors.lastname: Lee
mesh_terms: D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D012984:Software; D016896:Treatment Outcome; D014589:Utah
keywords: activity-based cost accounting; care costs; care outcomes; care quality; care value