{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T14:42:51Z","timestamp":1767796971166,"version":"3.49.0"},"reference-count":57,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T00:00:00Z","timestamp":1766016000000},"content-version":"unspecified","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,11,27]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To explore the perceived importance of essential Value-Based Healthcare (VBHC) and patient-centred care elements within operational military healthcare among wounded service members (WSM), military surgeons (MS) and medical commanders, and to identify preconditions that enable the delivery of patient-centred care and relevant medical outcomes during military operations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A two-round Delphi study was conducted following the Accurate Consensus Reporting Document guideline. An initial list of 17 preconditions was developed through a narrative-style literature review and expert-panel discussion. Preconditions were rated on a four-point Likert scale (\u2018not important\u2019 to \u2018very important\u2019) to reach consensus on \u2018military-oriented\u2019 preconditions for patient-centred trauma care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>An in-person expert-panel meeting and subsequent online Delphi surveys conducted between March 2020 and September 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The expert panel consisted of Dutch military healthcare leaders and clinical specialists. A total of 30 participants completed both Delphi rounds, including 17 MS and commanding officers (Group 1) and 13 WSM (Group 2) with deployment experience in Uruzgan, Afghanistan, ensuring balanced representation of care providers, facilitators and recipients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Primary outcome: identification of military-oriented preconditions essential for patient-centred and value-based trauma care. Secondary outcome: conceptual contribution to the future development of patient-centred outcome measures for military trauma populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Consensus was reached on 10 preconditions perceived as important or very important. While Group 1 prioritised operational readiness and procedural efficiency, Group 2 emphasised communication, shared decision-making and family involvement. Both groups rated informed consent, timely treatment registration and patient safety as the most critical elements, demonstrating convergence between logistic-oriented and patient-oriented perspectives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Integrating VBHC principles into military medical doctrine can reconcile operational readiness with patient-centred care. The consensus-based preconditions identified in this study provide a foundation for developing measurable outcomes that reflect value for both patients and the military health system and can guide future VBHC implementation in trauma-related operational care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-101224","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T11:50:41Z","timestamp":1766145041000},"page":"e101224","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Development of a set of value-based healthcare preconditions supporting military trauma patients in military operations: a Delphi study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7551-2842","authenticated-orcid":false,"given":"Henk","family":"van der Wal","sequence":"first","affiliation":[{"name":"Department of Surgery, Trauma Research Unit, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands"},{"name":"Defense Healthcare Organisation, Netherlands Ministry of Defence, Utrecht, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tonnie","family":"Dulk","sequence":"additional","affiliation":[{"name":"Defense Healthcare Organisation, Netherlands Ministry of Defence, Utrecht, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thijs","family":"van Dongen","sequence":"additional","affiliation":[{"name":"Defense Healthcare Organisation, Netherlands Ministry of Defence, Utrecht, the Netherlands"},{"name":"Department of Surgery, Alrijne Hospital Leiden, Leiden, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rigo","family":"Hoencamp","sequence":"additional","affiliation":[{"name":"Department of Surgery, Trauma Research Unit, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands"},{"name":"Defense Healthcare Organisation, Netherlands Ministry of Defence, Utrecht, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9973-3746","authenticated-orcid":false,"given":"Kees","family":"Ahaus","sequence":"additional","affiliation":[{"name":"Erasmus School of Health Policy and Management, Department Health Services Management and Organisation, Erasmus University Rotterdam, Rotterdam, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"2026010703475017000_15.12.e101224.1","first-page":"4","article-title":"Strengthening NATO in a more unpredictable world: the Vilnius summit","volume":"47","author":"Berti","year":"2023","journal-title":"Atlantisch Perspectief"},{"key":"2026010703475017000_15.12.e101224.2","unstructured":"Defence Mo , ed. 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