Factors Influencing Two-Year Health Care Costs in Patients Undergoing Revision Lumbar Fusion Procedures: A Guide to Where Should We Target Our Cost and Quality Improvement Initiatives

2012 ◽  
Vol 12 (9) ◽  
pp. S9-S10
Author(s):  
Scott L. Parker ◽  
Saniya S. Godil ◽  
David N. Shau ◽  
Stephen K. Mendenhall ◽  
Clinton J. Devin ◽  
...  
2012 ◽  
Vol 16 (4) ◽  
pp. 323-328 ◽  
Author(s):  
Scott L. Parker ◽  
David N. Shau ◽  
Stephen K. Mendenhall ◽  
Matthew J. McGirt

Object Revision lumbar fusion procedures are technically challenging and can be associated with tremendous health care resource utilization and cost. There is a paucity of data regarding specific factors that significantly contribute to increased cost of care. In light of this, the authors set out to identify independent risk factors predictive of increasing 2-year direct health care costs after revision lumbar fusion. Methods One hundred fifty patients undergoing revision instrument-assisted fusion for adjacent-segment disease (50 cases), pseudarthrosis (47 cases), or same-level stenosis (53 cases) were included in this study. Patient demographics, comorbidities, preoperative health states as assessed by patient-reported outcome questionnaires and perioperative complications were collected and analyzed. Two-year back-related medical resource utilization and direct health care costs were assessed. The independent association of all variables to increasing cost was assessed using multivariate linear regression analysis. Results There was a wide range ($24,935–$63,769) in overall 2-year direct costs for patients undergoing revision lumbar fusion (mean $32,915 ± $8344 [± SD]). Preoperative variables independently associated with 2-year direct health care costs included diagnosis of congestive heart failure, more severe leg pain (visual analog scale), greater back-related disability (Oswestry Disability Index), and worse mental health (12-Item Short Form Health Survey Mental Component Summary score). There was a 1.1- to 1.2-fold increase in cost for patients in the greatest quartiles compared with those in the lowest quartiles for these variables. Surgical site infection, return to the operating room, and spine-related hospital readmission during the 90-day global health period were postoperative variables independently associated with 2-year cost. Patients in the greatest versus lowest quartiles had a 1.7- to 1.9-fold increase in cost for these variables. Conclusions Revision lumbar fusion can be associated with considerable 2-year health care costs. These costs can also vary widely among patients, as evidenced by the 2.6-fold overall cost range in this series. Although comorbidities and preoperative severity of disease states contribute to cost of care, the primary drivers of increased cost include perioperative complications such as surgical site infection, return to the operating room, and readmission during the global health period. Measures focused on health service improvement will be most successful in reducing the cost of care for patients undergoing revision lumbar fusion.


2021 ◽  
Vol 12 ◽  
pp. 215013272110002
Author(s):  
Sirikan Rojanasarot ◽  
Angeline M. Carlson ◽  
Wendy L. St. Peter ◽  
Pinar Karaca-Mandic ◽  
Julian Wolfson ◽  
...  

Introduction/Objectives: Enhancing Care for Patients with Asthma (ECPA), a year-long provider-focused, multi-state, multi-clinic quality improvement program, decreased avoidable utilizations among patients with asthma, but its effects on health care expenditures were not determined. This study examined the translational and sustainable effects of improved care through ECPA on individual-level total health care costs due to asthma. Methods: We conducted a retrospective pretest-posttest quasi-experimental study in which attributed 1683 patients in a 12-month pre-ECPA implementation period served as their own control. We constructed the total annual asthma-related health care costs per patient occurred during pre-ECPA implementation, ECPA implementation, and post-ECPA completion. We used 3-level generalized linear mixed models (GLMMs) to estimate the ECPA effect on the annual health care costs and account for correlation between the repeated outcome measures for each patient and nested clinic. All costs were adjusted for inflation to 2014 U.S. dollars, the last year of program observation. Results: Total asthma-related health care costs among the 1683 included patients decreased from an average of $7033 to $3237 per person-year (pre-ECPA implementation vs implementation). Using the cost data from the 12-month pre-ECPA implementation period as a reference, GLMMs found that the ECPA implementation was associated with a reduction in total annual asthma-related health care costs by 56.4% (95% CI −60.7%, −51.8%). During the 12-months after ECPA completion period, health care costs were also found to be significantly lower, experiencing a 57.3% reduction. Conclusions: The economic benefits of ECPA provide a justification to adopt this quality improvement initiative to more primary care clinics at a national level.


2012 ◽  
Vol 12 (9) ◽  
pp. S103-S104
Author(s):  
Scott L. Parker ◽  
Saniya S. Godil ◽  
David N. Shau ◽  
Stephen K. Mendenhall ◽  
Clinton J. Devin ◽  
...  

1993 ◽  
Vol 9 (3) ◽  
pp. 369-379 ◽  
Author(s):  
Taryn Vian ◽  
Shabira Verjee ◽  
Richard B. Siegrist

AbstractNational concern about escalating health care costs and inefficiencies in delivery systems has created demand for informatics technology such as decision-support systems. This paper discusses the pressing need for better cost information in health care and how decision-support technology meets this need. Future directions for the technology also are discussed.


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