scholarly journals Bending the cost curve: time series analysis of a value transformation programme at an academic medical centre

2019 ◽  
Vol 28 (6) ◽  
pp. 449-458 ◽  
Author(s):  
Steven C Chatfield ◽  
Frank M Volpicelli ◽  
Nicole M Adler ◽  
Kunhee Lucy Kim ◽  
Simon A Jones ◽  
...  
Keyword(s):  
Time Series ◽  
Length Of Stay ◽  
Time Series Analysis ◽  
Hospital Mortality ◽  
Cost Of Care ◽  
Medical Centre ◽  
Academic Medical Centre ◽  
Series Analysis ◽  
Academic Medical ◽  
The Cost

BackgroundReducing costs while increasing or maintaining quality is crucial to delivering high value care.ObjectiveTo assess the impact of a hospital value-based management programme on cost and quality.DesignTime series analysis of non-psychiatric, non-rehabilitation, non-newborn patients discharged between 1 September 2011 and 31 December 2017 from a US urban, academic medical centre.InterventionNYU Langone Health instituted an institution-wide programme in April 2014 to increase value of healthcare, defined as health outcomes achieved per dollar spent. Key features included joint clinical and operational leadership; granular and transparent cost accounting; dedicated project support staff; information technology support; and a departmental shared savings programme.MeasurementsChange in variable direct costs; secondary outcomes included changes in length of stay, readmission and in-hospital mortality.ResultsThe programme chartered 74 projects targeting opportunities in supply chain management (eg, surgical trays), operational efficiency (eg, discharge optimisation), care of outlier patients (eg, those at end of life) and resource utilisation (eg, blood management). The study cohort included 160 434 hospitalisations. Adjusted variable costs decreased 7.7% over the study period. Admissions with medical diagnosis related groups (DRG) declined an average 0.20% per month relative to baseline. Admissions with surgical DRGs had an early increase in costs of 2.7% followed by 0.37% decrease in costs per month. Mean expense per hospitalisation improved from 13% above median for teaching hospitals to 2% above median. Length of stay decreased by 0.25% per month relative to prior trends (95% CI −0.34 to 0.17): approximately half a day by the end of the study period. There were no significant changes in 30-day same-hospital readmission or in-hospital mortality. Estimated institutional savings after intervention costs were approximately $53.9 million.LimitationsObservational analysis.ConclusionA systematic programme to increase healthcare value by lowering the cost of care without compromising quality is achievable and sustainable over several years.

scholarly journals Prediction Methods for Routine Maintenance Costs of a Reinforced Concrete Beam Bridge Based on Panel Data

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Xiaoli Shi ◽  
Bingbing Zhao ◽  
Yuling Yao ◽  
Feng Wang
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Concrete Beam ◽  
Reinforced Concrete Beam ◽  
Maintenance Cost ◽  
Analysis Method ◽  
Series Analysis ◽  
The Cost ◽  
Beam Bridge ◽  
Physical Engineering

In order to make informed decisions on routine maintenance of bridges of expressways, the hierarchical regression analysis method was used to quantify factors influencing routine maintenance cost. Two calculation models for routine maintenance cost based on linear regression and time-series analysis were proposed. The results indicate that the logarithm of the historical routine maintenance cost is the dependent variable and the bridge age is the independent variable. The linear regression analysis was used to obtain a cost prediction model for routine maintenance of a beam bridge, which was combined with the quantity and price, and verified by a physical engineering example. In order to cope with the cost changes and future demands brought about by the emergence of new maintenance technologies, the time-series analysis method was used to obtain a model to predict the engineering quantities for the routine maintenance of a bridge based on standardized minor repair engineering quantities. Taking into account the actual cost of the minor repair project as well as the time-series analysis’ sample size demands, the annual engineering quantity was randomly decomposed into four quarterly data quantities, and the time-series analysis result was verified by physical engineering. These results can improve the calculation accuracy of the routine maintenance costs of reinforced concrete beam bridges. Furthermore, it can have a certain application value for improving the cost measurement module of bridge maintenance management systems.

Time Series Analysis of Variables Associated With Daily Mean Emergency Department Length of Stay

2007 ◽  
Vol 49 (3) ◽  
pp. 265-271 ◽  
Author(s):  
Niels K. Rathlev ◽  
John Chessare ◽  
Jonathan Olshaker ◽  
Dan Obendorfer ◽  
Supriya D. Mehta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Length Of Stay ◽  
Time Series Analysis ◽  
Series Analysis

Utilisation of Acupuncture at An Academic Medical Centre

2010 ◽  
Vol 28 (4) ◽  
pp. 189-190 ◽  
Author(s):  
Ann Vincent ◽  
Kelly M Kruk ◽  
Stephen S Cha ◽  
Brent A Bauer ◽  
David P Martin
Keyword(s):  
Health Insurance ◽  
Spinal Pain ◽  
Primary Diagnosis ◽  
Medical Centre ◽  
Clinical Use ◽  
Academic Medical Centre ◽  
Insurance Carrier ◽  
Academic Medical ◽  
The Usa ◽  
The Cost

Objective To provide information about the clinical use of acupuncture at an academic medical centre in the USA. Methods A retrospective review of 904 patients (receiving 6070 treatments) who were referred for acupuncture treatment at the Mayo Clinic (Rochester, Minnesota, USA) between 1 January 2004 and 31 December 2008. Data gathered included age, sex, primary diagnosis, number of treatments per diagnosis and health insurance carrier. Results The mean (SD) age of the patients was 53.4 (16.2) years; 73.8% were female and 26.2% were male. The three most common diagnostic categories for which acupuncture was used were spinal pain (33.4%), pain (other) (25.1%) and joint pain (12.3%). About 42% of visits were not covered by health insurance carriers and hence patients had to pay themselves. For the remaining 58% of visits, health insurance carriers picked up all or part of the cost of the acupuncture treatments. Conclusion The results indicate that pain is the most common reason for use of acupuncture in an academic medical centre and that women use acupuncture more than men. This is one of the few reports of clinical use of acupuncture at academic medical centres in the USA.

scholarly journals Predicting hospital mortality for intensive care unit patients: Time-series analysis

2019 ◽  
Vol 26 (2) ◽  
pp. 1043-1059 ◽  
Author(s):  
Aya Awad ◽  
Mohamed Bader-El-Den ◽  
James McNicholas ◽  
Jim Briggs ◽  
Yasser El-Sonbaty
Keyword(s):  
Intensive Care Unit ◽  
Time Series ◽  
Intensive Care ◽  
Time Series Analysis ◽  
Intensive Care Unit Admission ◽  
Hospital Mortality ◽  
Prediction Models ◽  
Scoring Systems ◽  
Machine Learning Classification ◽  
Series Analysis

Current mortality prediction models and scoring systems for intensive care unit patients are generally usable only after at least 24 or 48 h of admission, as some parameters are unclear at admission. However, some of the most relevant measurements are available shortly following admission. It is hypothesized that outcome prediction may be made using information available in the earliest phase of intensive care unit admission. This study aims to investigate how early hospital mortality can be predicted for intensive care unit patients. We conducted a thorough time-series analysis on the performance of different data mining methods during the first 48 h of intensive care unit admission. The results showed that the discrimination power of the machine-learning classification methods after 6 h of admission outperformed the main scoring systems used in intensive care medicine (Acute Physiology and Chronic Health Evaluation, Simplified Acute Physiology Score and Sequential Organ Failure Assessment) after 48 h of admission.

scholarly journals Time Series Analysis of Emergency Department Length of Stay per 8-Hour Shift

2012 ◽  
Vol 13 (2) ◽  
pp. 163-168 ◽  
Author(s):  
Niels Rathlev ◽  
Dan Obendorfer ◽  
Laura White ◽  
Casey Rebholz ◽  
Brendan Magauran ◽  
...  
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Length Of Stay ◽  
Time Series Analysis ◽  
Series Analysis

Implementation of 24/7 radiology services in an academic medical centre level 1 trauma centre: Impact on trauma resuscitation unit length of stay and economic benefit analysis

Injury ◽  
2013 ◽  
Vol 44 (1) ◽  
pp. 75-79 ◽  
Author(s):  
Uttam K. Bodanapally ◽  
Kathirkamanathan Shanmuganathan ◽  
Kavitha Nutakki ◽  
Stuart E. Mirvis ◽  
Clint W. Sliker ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Economic Benefit ◽  
Unit Length ◽  
Trauma Centre ◽  
Medical Centre ◽  
Benefit Analysis ◽  
Trauma Resuscitation ◽  
Academic Medical Centre ◽  
Academic Medical ◽  
Level 1

Abstract 18: The Impact of an Ambulation Orderly Program on Hospital Outcomes for Patients with Recent Open Heart Surgery

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Quinn R Pack ◽  
Saki Miwa ◽  
Erin Woodbury ◽  
Richard Engelman ◽  
Tara Lagu ◽  
...  
Keyword(s):  
Time Series ◽  
Length Of Stay ◽  
Time Series Analysis ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Interrupted Time Series Analysis ◽  
Discharge Disposition ◽  
Series Analysis ◽  
The Impact

Introduction: The detriments of prolonged bedrest are well described, yet most hospitals fail to provide enough ambulation to their patients to prevent significant deconditioning and patient harm. One potential strategy for overcoming this problem is the use of an ambulation orderly (AO), an employee whose primary responsibility is to walk patients up to 3-4 times per day. In May 2013, our hospital instituted an AO program among post-operative cardiac surgical patients. We hypothesized that the introduction of an AO program would be associated with improved patient outcomes. Methods: We evaluated all patients undergoing either coronary artery bypass and/or cardiac valve surgery between September 2012 and March 2014. We evaluated the impact of the AO program on post-operative length of stay (LOS), hospital complications, discharge disposition, and 30-day hospital readmission with both a pre-post study design and an interrupted time-series analysis. Results: We identified 925 patients (68.3 years, 68% male, 92% white) during the study period, with no major shifts observed in patient demographics over the study period. Compared to the pre-AO group, the median post-operative LOS (IQR) decreased from 8 (6 to 11) to 7 (6 to 10) days, p < 0.001 for the post-AO group. Additionally, variability around the median length of stay decreased significantly (Brown-Forsythe p = 0.05). See Figure. Time series analysis found that there was no significant baseline trend in LOS (+0.07, p =0.53), but that initiation of the AO program was associated with decreased post-operative LOS (-1.1 ±0.8 days, p =0.16), and a favorable change in the post-AO slope (- 0.30 ± 0.15 days, p = 0.048). Other outcomes were unaffected. Conclusions: The institution of an AO program at our hospital was associated with both a significantly reduced LOS as well as reduced LOS variability, without a change in the rate of hospital complications or 30-day readmission. These results suggest that an AO program is a promising strategy for improving quality and decreasing costs.

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