持续增加的医疗支出并没有产生相应的患者结果改善，这导致美国医疗保健利益相关者强调以价值为基础的护理。过渡到这种模式需要所有团队成员采用一个新的战略和组织框架。描述和报告一种实施新型患者中心的以价值为基础的“最佳外科护理”（OSC）框架的策略，以及对肾脏手术进行验证和成本分析。进行了一个单一机构的2014年至2019年的病例观察研究。多学科团队使用提供者为基础（“自下而上”）和“临床领导力”为基础（“自上而下”）的策略，通过核心和特定过程的指标定义了OSC。确定基线OSC率，同时通过总直接成本的变异系数（CV）来确定实现OSC的比例。通过多变量线性回归调整患者特征，比较OSC和非OSC遭遇的成本。进行了30,261个围手术期病例的分析。在实施OSC框架之后，使用核心（25%）和特定过程（26%）指标，各过程各领域的OSC率都提高了。在测试的肿瘤中，肾癌外科病例的OSC率提高最多（67%），成本变异最小（CV 0.5）。调整通胀后，OSC与所有肿瘤类型的总成本节省相关（p < 0.05）。与非OSC病例相比，肾脏手术的OSC成本比降低显著（p < 0.01），每个OSC遭遇的估计成本节省为$2445.87。将机构变革引导朝向优化外科护理和强调价值，而不仅仅是专注于降低成本，与改善结果和潜在的降低成本相关。实施策略需要进行连续性绩效分析，吸引和教育提供者，并进行持续调整以取得持久的结果。在本研究中，我们报告了在一个国家癌症研究所指定的综合癌症中心使用一种新型的“最佳外科护理”框架过渡到以价值为基础的医疗保健模式的策略和结果。在五年后，我们观察到各专业的最佳外科护理病例增加，并有可能减少支出。我们得出结论，成功和持久的过渡的关键是实施策略，着重于持续评估和提供者参与。发表于Elsevier B.V.

The continued rise in healthcare expenditures has not produced commensurate improvements in patient outcomes, leading US healthcare stakeholders to emphasize value-based care. Transition to such a model requires all team members to adopt a new strategic and organizational framework.To describe and report a strategy for the implementation of a novel patient-centered value-based "optimal surgical care" (OSC) framework, with validation and cost analysis in kidney surgery.An observational study of care episodes at a single institution from 2014 to 2019 was conducted.Multidisciplinary teams defined OSC by core and procedure-specific metrics using a combination of provider-based ("bottom-up") and "clinical leadership"-based ("top-down") strategies. Baseline OSC rates across were established, while identifying proportions of OSC achieved by coefficient of variation (CV) in total direct costs. Multivariable linear regression comparing cost between OSC and non-OSC encounters was performed, adjusting for patient characteristics.An analysis of 30 261 perioperative care episodes was performed. Following the implementation of an OSC framework, there was an increase in OSC rates across all procedure buckets using core (25%) and procedure-specific (26%) metrics. Among the tumors tested, kidney cancer surgical episodes held the highest OSC rate improvement (67%) with lowest variability in cost (CV 0.5). OSC was associated with significant total cost savings across all tumor types after adjusting for inflation (p < 0.05). Compared with non-OSC episodes, a significant reduction in the cost ratio of OSC was noted for renal surgery (p < 0.01), with estimated costs savings of $2445.87 per OSC encounter.Institutional change directing efforts toward optimizing surgical care and emphasizing value rather than focusing solely on expense reduction is associated with improved outcomes, while potentially reducing costs. The strategy for implementation requires serial performance analyses, engaging and educating providers, and continuous ongoing adjustments to achieve durable results.In this study, we report our strategy and outcomes for transitioning to a value-based healthcare model using a novel "optimal surgical care" framework at a National Cancer Institute-designated comprehensive cancer center. We observed an increase in optimal surgical care episodes across all specialties after 5 yr, with a potential associated reduction in cost expenditure. We conclude that the key to a successful and sustained transition is the implementation strategy, focusing on continual review and provider engagement.Published by Elsevier B.V.