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Development of a questionnaire for measuring the advance in Value-based Digital Health


Marisa Merino Hernandez ,

Osi Tolosaldea Osakidetza,Spain, ES
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Maider Urtaran-Laresgoiti,

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Esther Lazaro,

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Marisol Basabe,

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Olga Solas Gaspar

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In the context of rapid technological advance in healthcare and increasing popularity of the Value-based Healthcare (VBHC) paradigm, the need to establish theoretical connection between Digital Health and VBHC framed under the learnings of the integrated care literature has been identified as useful for organizations interested in progressing in this field. Therefore, the purpose of this research is to develop a tool for measuring the advance of organizations in the implementation of the Value-based Digital Health (VBDH) concept.


Data Sources: A scoping literature review, eight telephone-based semi-structured key informant interviews, and face and conceptual validation sessions by an expert panel consisting on four experts of different fields: the manager of an Integrated Care Organization, one top manager of the largest patient association in Spain, a health services researcher, and an Academic Expert on Organization Theory.

Study Design: The questionnaire was developed from December 2020 to January 2021. Qualitative methods were used to elicit, refine, and prioritize the items to include in the questionnaire.

Data Collection: 1) Two technical development meetings by the research team, combined with 2) the revision of the input gathered through key informants, and 3) the two rounds of consultation with the expert panel, were used in an iterative process to develop the final version.

The scoping literature review and semi-structured interviews formed the basis for the initial draft of key domains to be included in the VBDH concept. Expert panel members drafted questions under 5 domains identified from the four theoretical streams of literature: Value-based Healthcare, Digital Health, Integrated Care and Learning Organization. Additional written feedback on the completeness of the domains was obtained from the first round of expert consultation. The domains and items were refined and reviewed by the research team to create the final questionnaire. In the second round, the expert panel check the face and conceptual validity of the tool.


The iterative development process yielded 38 questions grouped under five domains: (1) Leadership and Strategy; (2) Culture and enabling environment; (3) Processes and practices; (4) Learning and evaluation system; (5) Incentives and funding.

Two open questions were added to help further advancement in the conceptualization of VBDH.


VBDH arises as a new concept with limited conceptual and practical development in real context. Although the growing acceptance of digital solutions is key to promote value-based care and improve patient outcomes, a practical tool to measure organizational advance in VBDH is needed.


The development of this questionnaire is the first step in the conceptualization and real-life application of the VBDH.

Lessons Learned

VBDH is a concept that requires an appropriate framing in the integrated care literature to be actionable.


VBDH is a nascent construct that requires further conceptual refinement. Moreover, the tool designed for the measurement of VBDH is a first step that is not psychometrically validated yet.

Suggestions for further research

The next step is a survey of a relevant audience in order to allow the psychometric validation of the tool.

How to Cite: Hernandez MM, Urtaran-Laresgoiti M, Lazaro E, Basabe M, Gaspar OS. Development of a questionnaire for measuring the advance in Value-based Digital Health. International Journal of Integrated Care. 2022;22(S1):88. DOI:
Published on 08 Apr 2022.


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