PP275 Incorporating Quality-Of-Care Indicators In Health Economic Modelling: A Case-Study On Surgical Site Infections In Cardiac Surgery

2021 ◽  
Vol 37 (S1) ◽  
pp. 31-32
Author(s):  
Rhodri Saunders ◽  
Eleftheria Pervolaraki
Keyword(s):  
Health Economic ◽  
Cardiac Surgery ◽  
Quality Of Care ◽  
Cost Benefit ◽  
Surgical Site Infections ◽  
Cost Of Care ◽  
Economic Modelling ◽  
Post Discharge ◽  
Potential Cost

IntroductionSurgical site infections (SSIs) are preventable adverse events placing a large burden on service providers. Reusable electrocardiogram lead-and-wire systems can hold infection vectors after cleaning. Single-patient-use cable-and-lead systems (spECG) may help prevent cross-contamination and SSIs. SSIs are commonly included in incentive schemes as quality-of-care indicators. Readmissions within 30 days due to SSI are not reimbursed by the UK's National Health Service (NHS). Reducing SSIs could improve patient care and result in cost-of-care savings. The cost-benefit of implementing spECG was investigated in this study.MethodsNHS Digital 2019 data for cardiac surgeries were assessed for SSIs occurring during the index event or 90 days post discharge. Data from 88 centers performing 1,000 surgeries or more were used to update a published health economic model of the cardiac surgery care pathway. The population was on average 68 years old, 18 percent female, 33 percent obese, and 28 percent diabetic. Costs are reported in 2019 GBP (2019 EUR) and were sourced from NHS reports.ResultsIn total, 2,580 in-hospital SSIs were reported from 317,825 cardiac surgeries, resulting in an increased length-of-stay (LOS) of between 4.4 to 29.4 days. The 1,975 SSI-related, post-discharge readmissions’ mean LOS was 13.9 days. Cost-of-care was GBP8,127 (EUR9,259) per patient, in line with NHS data. Implementing spECG reduced per-case-costs to GBP8,094 (EUR9,221), saving GBP33 (EUR38): a 3.5-fold return-on-investment. Savings-drivers were fewer SSIs, reduced LOS, and fewer readmissions (a reduction of 29% within 30-days, resulting in cost-offsets of approximately GBP230 (EUR262)/readmission).ConclusionsThis study suggests that the implementation of spECG could provide cost-benefit in reducing the burden of SSIs related to cardiac surgery. In addition to cost-of-care, the readmissions would have additionally burdened hospitals, as 29 percent would not have been reimbursed. Health-economic analyses should consider not only potential cost-savings of innovative products, but also incorporate quality-of-care indicators. This further aligns payer considerations with the common end-goal of providing maximum benefit to patients.

The impact of sex, gender and healthcare system on quality of care among young adults with acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Raparelli ◽  
L Pilote ◽  
H Behlouli ◽  
J Dziura ◽  
H Bueno ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Young Adults ◽  
Quality Of Care ◽  
Healthcare System ◽  
Quality Indicators ◽  
Funding Source ◽  
Post Discharge ◽  
Single Payer

Abstract Background The quality of care among young adults with acute myocardial infarction (AMI) may be related to biological sex, psycho-socio-cultural (gender) determinants or healthcare system-level factors. Purpose To examine whether sex, gender, and the type of healthcare system influence the quality of AMI care among young adults. Methods A total of 4,564 AMI young adults (<55 years) (59% women, 47 years, 66% US) were analyzed from the VIRGO and GENESIS-PRAXY studies consisting of single-payer (Canada, Spain) versus multipayer (US) systems. For each patient treated in each system we calculated a quality of care score (QCS) for pre-AMI (1-year pre admission), in-hospital, and post-AMI (1-year post discharge) phases of care (number of quality indicators received divided by the total number [range=0–100%], with higher scores indicating better quality). Ordinal logistic or linear regression models, and 2-way interactions between sex, gender and healthcare system were tested. Results Women in the multipayer system had the highest risk factor burden. Across the phases of care for AMI, 20% of quality indicators were missed in both sexes. High stress, earner status, and social support were associated with a higher QCS in the pre-AMI phase, whereas only employment and earner status were associated with QCS in all other phases. In the pre-AMI phase, women had higher QCS than men, mainly in the single-payer system (adjusted-OR=1.85, 95% CI 1.46,2.35 vs. 1.07, 95% CI 0.84,1.36, P-interaction= 0.002). Regardless of sex, only employment status had a greater effect in the multipayer system (adjusted-OR=0.59, 95% CI 0.44,0.78 vs 1.13, 95% CI 0.89,1.44, P-interaction <0.001). In the in-hospital phase, women had a lower QCS than men, especially in the multipayer system (adjusted-mean-difference: −2.48, 95% CI-3.87, −1.08). Employment was associated with a higher QCS (2.0, 95% CI 0.9–3.17, P-interaction >0.05). Finally, in the post-AMI phase, men and women had a lower QCS, predominantly in the multipayer system. However, primary earners had higher QCS regardless of system. Conclusion Sex, gender, and healthcare system affected the quality of care after AMI. Women had a poorer in-hospital than men and both women and men had suboptimal post-discharge care. Being unemployed lowered the quality of care, more so in the multipayer system. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health and Research (CIHR)

Abstract 358: Annual Quality of Care Evaluations of Cardiac Surgery in British Columbia

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
James G Abel ◽  
Daniel R Wong ◽  
Carmen H Ng ◽  
Lillian Ding ◽  
Andrew Kmetic
Keyword(s):  
British Columbia ◽  
Cardiac Surgery ◽  
Quality Of Care ◽  
Risk Model ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Administrative Databases ◽  
Annual Review ◽  
Rbc Transfusion

Background: Cardiac Services BC (CSBC) is responsible for planning, coordinating, monitoring, and, in some cases, funding cardiac services across British Columbia (BC) in collaboration with senior administrators and physicians from five regional health authorities. CSBC maintains the BC Cardiac Registry (BCCR), a longitudinal clinical registry of all invasive cardiac procedures performed in BC. For over 10 years, CSBC has used BCCR data to evaluate annually quality of care indicators for isolated coronary artery bypass graft (CABG), isolated valve, and CABG+valve surgeries. Methods: In preparation for each annual review, CSBC meets with an established Planning Committee of representative surgeons. BCCR data is linked to provincial Vital Statistics data, to the national Discharge Abstract Database, and for the last 3 yearly analyses to the provincial Central Transfusion Registry which provides robust data on red blood cell (RBC) transfusion. At the annual review, CSBC meets with surgeons who are included in the analyses to present the indicator data. Results: In the 2012 evaluation, the following quality of care indicators were presented for the 2007-2011 period: 30-day mortality and 30-day stroke; 30-day RBC transfusion; and indicators for evidence-based medications at discharge. Risk-adjusted analyses were prepared for the 30-day mortality and 30-day stroke indicators to provide valid comparisons over time and according to hospital and surgeon. Patient characteristics and pre-procedural factors were included in the risk models. The risk-adjusted models performed well with C-statistics for the 30-day mortality models for isolated CABG, isolated valve, and CABG+valve surgeries of 0.86, 0.89, and 0.81, and for the 30-day stroke models 0.80, 0.83, and 0.74, respectively. Expected rates by hospital and by surgeon were determined from each risk model, and observed to expected (O/E) ratios were used for comparison of hospitals and surgeons. Rates of RBC transfusion varied by hospital, and a large reduction in transfusion rates from 69% (378 of 546) in 2007 to 43% (252 of 589) in 2011 was observed at one site with historically higher rates. Conclusion: Presenting quality of care indicators annually has raised awareness of outcome rates and variations which existed across the province. The annual process of engaging surgeons in the evaluation process and linkage with other administrative databases to obtain outcome data has been associated with a reduction in use of RBC transfusion and instigated further investigations into regional variation in mortality rates. The addition of new indicators and other risk-adjusted analyses in the future may further improve quality of care in cardiac surgery in BC.

Chest tube removal after cardiac surgery

1997 ◽  
Vol 17 (1) ◽  
pp. 34-38 ◽  
Author(s):  
SC Thomson ◽  
S Wells ◽  
M Maxwell
Keyword(s):  
Cardiac Surgery ◽  
Quality Of Care ◽  
Length Of Stay ◽  
Chest Tube ◽  
Chest Tubes ◽  
Tube Removal ◽  
Chest Tube Removal

Prompt remove of chest tubes by RNs has allowed earlier and more aggressive ambulation of our patients and, along with other interventions, has decreased length of stay by 1.5 days while improving quality of care. Proper education, both didactic and clinical, is the key component in preparing RNs to safely and effectively perform this procedure.

scholarly journals Current Use of Intravenous (IV) Long Acting Antibiotic (LAA) Therapy in the Aetna Health Plan among Patients with Acute Bacterial Skin and Skin Structure Infection (ABSSSI)

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S339-S340
Author(s):  
Rajesh Mehta ◽  
Alison Edwards ◽  
Katelyn R Keyloun ◽  
Nicole Bonine ◽  
Iver Juster
Keyword(s):  
Sensitivity Analysis ◽  
Quality Of Care ◽  
Cost Savings ◽  
Potential Cost ◽  
Treatment Pathways ◽  
Inpatient Management ◽  
Inpatient Population ◽  
Long Acting ◽  
Potential Opportunity

Abstract Background In an effort to lower costs and improve quality of care, there is potential to change the treatment landscape for low-risk (i.e., less severe) ABSSSI patients who historically required inpatient management, a costly option. Outpatient IV treatment pathways have been shown to be a cost-saving option for hospitals and insurers. The objective was to quantify the potential opportunity for reducing cost of ABSSSI treatment in an insured Commercial and Medicare Aetna population. Methods Adult patients between January 2013 and July 2016 were identified with a primary ABSSSI claim (Table 1) in the Aetna fully-insured Commercial and Medicare insurance claims database. ABSSSI encounters were identified with insurance eligibility for the 7 months prior to and no evidence of ABSSSI in the 30 days prior to the ABSSSI claim. Demographic and clinical data were described, including length of stay (LOS) and allowed cost for inpatient encounters with data. Inpatient encounters without evidence of severity (e.g., codes for major complications or comorbidities) were considered potential candidates for an outpatient LAA pathway. A sensitivity analysis for LOS and cost was run including all ABSSSI patients with LAA dispenses through 2016 (i.e., inclusion/exclusion criteria did not need to be met). Results 194,023 ABSSSI encounters were identified, most receiving non-IV treatment (90%). 18,603 received IV treatment, where 83% initially presented to the emergency room and the majority were admitted (97%). Of the 28 encounters with LAA use, 7 were inpatient. Of all current inpatient encounters (N = 9,019 after Jan 1, 2015), the majority (N = 7,005; 78%) where considered potential LAA pathway candidates. Comparing inpatient encounters with vs. without LAA use, mean LOS and cost differed (Table 2: 4.1 days and $14,295 vs. 9.0 days and $23,194, respectively). A sensitivity analysis supported similar mean LOS and cost for all inpatient LAA dispenses. Conclusion Current use of LAA in an inpatient population is limited but resulted in potential cost-savings. Most of the inpatient population was identified as potential candidates for an outpatient LAA pathway. Research on utilization and quality of care for outpatient IV treatment pathways with LAA is warranted. Disclosures K. R. Keyloun, Allergan: Employee, Salary N. Bonine, Allergan: Employee, Salary

Health economic evaluation in ophthalmology

2020 ◽  
pp. bjophthalmol-2020-316880
Author(s):  
Alp Atik ◽  
Keith Barton ◽  
Augusto Azuara-Blanco ◽  
Nathan M Kerr
Keyword(s):  
Health Economic ◽  
Economic Evaluation ◽  
Clinical Decision Making ◽  
Health Economic Evaluation ◽  
Cost Benefit ◽  
Clinical Decision ◽  
Cost Utility ◽  
Economic Modelling ◽  
Increasing Demand ◽  
Healthcare Interventions

Health economic evaluation is the application of economic theories, tools and concepts to healthcare. In the setting of limited resources, increasing demand and a growing array of intervention options, economic evaluation provides a framework for measuring, valuing and comparing the costs and benefits of different healthcare interventions. This review provides an overview of the concepts and methods of economic evaluation, illustrated with examples in ophthalmology. Types of economic evaluation include cost-minimisation, cost-benefit, cost-effectiveness, cost-utility and economic modelling. Topics including utility measures, the quality-adjusted lifeyear, discounting, perspective and timeframe are discussed. Health economic evaluation is important to understand the costs and value of interventions in ophthalmology and to inform health policy as well as guide clinical decision-making.

scholarly journals The cost-effectiveness of physician assistants/associates: A systematic review of international evidence

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259183
Author(s):  
G. T. W. J. van den Brink ◽  
R. S. Hooker ◽  
A. J. Van Vught ◽  
H. Vermeulen ◽  
M. G. H. Laurant
Keyword(s):  
Systematic Review ◽  
Quality Of Care ◽  
Cost Effectiveness ◽  
Physician Assistants ◽  
Labor Cost ◽  
Cost Of Care ◽  
Complementary Role ◽  
Care Outcomes ◽  
The Cost

Background The global utilization of the physician assistant/associate (PA) is growing. Their increasing presence is in response to the rising demands of demographic changes, new developments in healthcare, and physician shortages. While PAs are present on four continents, the evidence of whether their employment contributes to more efficient healthcare has not been assessed in the aggregate. We undertook a systematic review of the literature on PA cost-effectiveness as compared to physicians. Cost-effectiveness was operationalized as quality, accessibility, and the cost of care. Methods and findings Literature to June 2021 was searched across five biomedical databases and filtered for eligibility. Publications that met the inclusion criteria were categorized by date, country, design, and results by three researchers independently. All studies were screened with the Risk of Bias in Non-randomised Studies—of Interventions (ROBIN-I) tool. The literature search produced 4,855 titles, and after applying criteria, 39 studies met inclusion (34 North America, 4 Europe, 1 Africa). Ten studies had a prospective design, and 29 were retrospective. Four studies were assessed as biased in results reporting. While most studies included a small number of PAs, five studies were national in origin and assessed the employment of a few hundred PAs and their care of thousands of patients. In 34 studies, the PA was employed as a substitute for traditional physician services, and in five studies, the PA was employed in a complementary role. The quality of care delivered by a PA was comparable to a physician’s care in 15 studies, and in 18 studies, the quality of care exceeded that of a physician. In total, 29 studies showed that both labor and resource costs were lower when the PA delivered the care than when the physician delivered the care. Conclusions Most of the studies were of good methodological quality, and the results point in the same direction; PAs delivered the same or better care outcomes as physicians with the same or less cost of care. Sometimes this efficiency was due to their reduced labor cost and sometimes because they were more effective as producers of care and activity.

PRIME MINISTER NATIONAL HEALTH PROGRAM: A CLIENT SATISFACTION SURVEY

2018 ◽  
Vol 7 (4) ◽  
pp. 206-212
Author(s):  
Rubina Hussain ◽  
Shaikh Hussain ◽  
Saima Hamid
Keyword(s):  
Quality Of Care ◽  
Client Satisfaction ◽  
Healthcare Access ◽  
Clinical Effectiveness ◽  
Poverty Line ◽  
Hospital Environment ◽  
Satisfaction Level ◽  
Post Discharge ◽  
Universal Healthcare

Introduction: Patient experience together with clinical effectiveness and patient safety is one of so called "Three pillars of quality". Benefits of good quality of care are increased client satisfaction level and program utilization. In Pakistan, major issue of people living poverty line is catastrophic heath expenditure so to overcome this issue a health insurance scheme PMNHP was launched and is a milestone towards universal healthcare access. BISP enrolees are eligible for program. Methods: A mixed method approach was employed by using quantitative summary statistics and qualitative thematic evaluation. Results: Overall satisfaction level was 77%, 13% were dissatisfied and 10% were uncertain. Disease wise satisfaction level among GB surgery was 95% and or surgery 88% patients with cancer and non-surgical cases were 11% dissatisfied district wise in SKD and Kotli were 100% Satisfied MZD 91% and ICT 61%. Qualitative analysis revealed themes of management, communication, hospital environment and quality of care 23 IDI's were conducted. There were issues with management, attitudes of healthcare provider, during hospital stay was not good and post discharge care was not explained properly. Satisfied patients were those who were informed well and given good care and those who lacked it were dissatisfied. Conclusion: Results suggest that more the patient is valued, given honoured and requisite quality of care more level of patient satisfaction, and same is with patient-provider relationship greater attention more fulfilment of expectations.

Sign in / Sign up

Export Citation Format

Share Document