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Conference Abstracts

Development of MORE: an evaluative tool for measuring value-based integrated care


Maider Urtaran-Laresgoiti

University Of Deusto, ES
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Ageing and chronicity, along with technological and pharmacological innovation upswing, require transformation of healthcare organizations and systems to focus on value-based integrated care (VBIC) models.

MORE (Spanish acronym for Madurez de las Organizaciones Sanitarias Orientadas a Resultados en Salud) is an initiative that pursues the commitment of healthcare organizations to progress on the delivery of VBIC as a means to allow health system sustainability. Its core element, a questionnaire for the initial situational analysis, is completed with a working methodology to first identify critical issues, and secondly define  a roadmap towards a VBIC driven organization.

We describe the design process and preliminary piloting results of the MORE questionnaire.


For the initial development of the questionnaire, a multidisciplinary group of experts in the field of health policy, management, health economics, pharma industry and consultancy was formed. A literature review to identify main topics and key elements in the value-based framework preceded the group discussion.

A kick off meeting of the group took place in February 2016, followed by 20 teleconference meetings. The last meeting was held in December 2017 to agree on the final version.

The preliminary version of items comprising the questionnaire was contrasted with a sample of potential users in healthcare organizations.

The final online version was tested for its usability, acceptability and user´s satisfaction before launching the pilot projects at four healthcare organizations in Spain in 2018. From these pilots, feedback from 45 interviewees was collected at working sessions after they completed the questionnaire and discussed on the results to define a roadmap for future improvement actions.


The questionnaire is an open access tool with 57 items structured in 5 main themes, which have been considered essential in a value-based healthcare management model: policy, care coordination, information systems, management and evaluation.

Feedback from users corroborated its potential to consider, from an integral perspective, all key elements and sensitize healthcare teams in the transformation towards a VBIC organization.


Although value-based healthcare delivery is a fashionable topic, there are not tools that allow organizations to self-assess their organizational maturity on this topic. MORE is intended to fill this gap as well as to expand current value-based healthcare approaches towards value-based integrated care by merging key concepts from both knowledge areas.


The MORE questionnaire presents an opportunity to analyze the situation of an organization with respect to VBIC and align teams towards it.

Lessons learned

The validation done with final users suggest that the MORE questionnaire is both applicable and easy use tool.


Transformation processes must go beyond the implementation of a tool and they require a favorable environment at all levels of the organization which would allow changes to happen. Therefore, MORE initiative has been conceived as a transformational project, being the application of the MORE questionnaire the starting point.

Suggestions for future research

Future psychometric validation would provide useful insights on content validity and internal consistency of the dimensions within the tool.


How to Cite: Urtaran-Laresgoiti M. Development of MORE: an evaluative tool for measuring value-based integrated care. International Journal of Integrated Care. 2021;21(S1):35. DOI:
Published on 01 Sep 2021.


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