scholarly journals Time-Driven Activity-Based Costing: A Better Way to Understand the Cost of Caring for Hip Fractures

2020 ◽  
Vol 11 ◽  
pp. 215145932095820
Author(s):  
Breanna L. Blaschke ◽  
Harsh R. Parikh ◽  
Sandy X. Vang ◽  
Brian P. Cunningham
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Financial Strain ◽  
Process Mapping ◽  
Activity Based Costing ◽  
Fracture Care ◽  
Patient Level ◽  
Reducing Costs ◽  
The Cost ◽  
Payment Models

Geriatric hip fractures are a common and costly injury. They are expected to surge in incidence and economic burden as the population ages. With an increasing financial strain on the healthcare system, payors and providers are looking toward alternative, value-based models to contain costs. Value in healthcare is the ratio of outcomes achieved over costs incurred, and can be improved by reducing cost while maintaining or improving outcomes, or by improving outcomes while maintaining or reducing costs. Therefore, an understanding of cost, the denominator of the value equation, is essential to value-based healthcare. Because traditional hospital accounting methods do not link costs to conditions, there has been little research to date on the costs of treating geriatric hip fractures over the entire cycle of care. The aim of this article is to summarize existing costing methodologies, and in particular, to review the strengths and limitations of Time-Driven Activity-Based Costing (TDABC) in orthopaedic trauma, especially as it pertains to the needs and challenges unique to hip fracture care. TDABC determines costs at the patient-level over the entire care cycle, allowing for population variability, while simultaneously identifying cost drivers that might inform risk-stratification for future alternative payment models. Through process mapping, TDABC also reveals areas of variation or inefficiency that can be targeted for optimization, and empowers physicians by focusing on costs in the control of the provider. Although barriers remain, TDABC is well-positioned to provide transparent costing and targets to improve the value of hip fracture care

scholarly journals Prior Admissions as a Risk Factor for Readmission in Patients Surgically Treated for Femur Fractures: Implications for a Potential Hip Fracture Bundle

2021 ◽  
Vol 12 ◽  
pp. 215145932199616
Author(s):  
Robert Erlichman ◽  
Nicholas Kolodychuk ◽  
Joseph N. Gabra ◽  
Harshitha Dudipala ◽  
Brook Maxhimer ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Hip Fracture ◽  
Logistic Regression Analysis ◽  
Hip Fractures ◽  
Surgical Procedure ◽  
Hospital Admissions ◽  
Fracture Care ◽  
Increased Risk ◽  
Payment Models

Introduction: Hip fractures are a significant economic burden to our healthcare system. As there have been efforts made to create an alternative payment model for hip fracture care, it will be imperative to risk-stratify reimbursement for these medically comorbid patients. We hypothesized that patients readmitted to the hospital within 90 days would be more likely to have a recent previous hospital admission, prior to their injury. Patients with a recent prior admission could therefore be considered higher risk for readmission and increased cost. Methods: A retrospective chart review identified 598 patients who underwent surgical fixation of a hip or femur fracture. Data on readmissions within 90 days of surgical procedure and previous admissions in the year prior to injury resulting in surgical procedure were collected. Logistic regression analysis was used to determine if recent prior admission had increased risk of 90-day readmission. A subgroup analysis of geriatric hip fractures and of readmitted patients were also performed. Results: Having a prior admission within one year was significantly associated (p < 0.0001) for 90-day readmission. Specifically, logistic regression analysis revealed that a prior admission was significantly associated with 90-day readmission with an odds ratio of 7.2 (95% CI: 4.8-10.9). Discussion: This patient population has a high rate of prior hospital admissions, and these prior admissions were predictive of 90-day readmission. Alternative payment models that include penalties for readmissions or fail to apply robust risk stratification may unjustly penalize hospital systems which care for more medically complex patients. Conclusions: Hip fracture patients with a recent prior admission to the hospital are at an increased risk for 90-day readmission. This information should be considered as alternative payment models are developed for hip fracture care.

scholarly journals Resolving Controversies in Hip Fracture Care: The Need for Large Collaborative Trials in Hip Fractures

2009 ◽  
Vol 23 (6) ◽  
pp. 479-484 ◽  
Author(s):  
Mohit Bhandari ◽  
Sheila Sprague ◽  
Emil H Schemitsch
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Fracture Care

scholarly journals COVID-19 pandemic and hip fractures: impact and lessons learned

2020 ◽  
Vol 1 (9) ◽  
pp. 530-540
Author(s):  
Mohamed Arafa ◽  
Samia Nesar ◽  
Hamza Abu-Jabeh ◽  
Ma Odette Remelou Jayme ◽  
Yegappan Kalairajah
Keyword(s):  
Hip Fracture ◽  
Hospital Stay ◽  
Hip Fractures ◽  
Care Service ◽  
Health Concern ◽  
Positive Group ◽  
Fracture Care ◽  
Significant Difference ◽  
The Uk ◽  
The Impact

Aims The coronavirus disease (COVID)-19 pandemic forced an unprecedented period of challenge to the NHS in the UK where hip fractures in the elderly population are a major public health concern. There are approximately 76,000 hip fractures in the UK each year which make up a substantial proportion of the trauma workload of an average orthopaedic unit. This study aims to assess the impact of the COVID-19 pandemic on hip fracture care service and the emerging lessons to withstand any future outbreaks. Methods Data were collected retrospectively on 157 hip fractures admitted from March to May 2019 and 2020. The 2020 group was further subdivided into COVID-positive and COVID-negative. Data including the four-hour target, timing to imaging, hours to operation, anaesthetic and operative details, intraoperative complications, postoperative reviews, COVID status, Key Performance Indicators (KPIs), length of stay, postoperative complications, and the 30-day mortality were compiled from computer records and our local National Hip Fracture Database (NHFD) export data. Results Hip fractures and inpatient falls significantly increased by 61.7% and 7.2% respectively in the 2020 group. A significant difference was found among the three groups regarding anaesthetic preparation time, anaesthetic time, and recovery time. The mortality rate in the 2020 COVID-positive group (36.8%) was significantly higher than both the 2020 COVID-negative and 2019 groups (11.5% and 11.7% respectively). The hospital stay was significantly higher in the COVID-positive group (mean of 24.21 days (SD 19.29)). Conclusion COVID-19 has had notable effects on the hip fracture care service: hip fracture rates increased significantly. There were inefficiencies in theatre processes for which we have recommended the use of alternate theatres. COVID-19 infection increased the 30-day mortality and hospital stay in hip fractures. More research needs to be done to reduce this risk. Cite this article: Bone Joint Open 2020;1-9:530–540.

scholarly journals Determining the cost-effectiveness requirements of an exoskeleton preventing second hip fractures using value of information

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Stefania Manetti ◽  
Giuseppe Turchetti ◽  
Francesco Fusco
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Cost Effective ◽  
Future Research ◽  
Base Case ◽  
Secondary Analyses ◽  
The Cost

Abstract Background Falls may lead to hip fractures, which have a detrimental effect on the prognosis of patients as well as a considerable impact on healthcare expenditures. Since a secondary hip fracture (SHF) may lead to even higher costs than primary fractures, the development of innovative services is crucial to limit falls and curb costs in high-risk patients. An early economic evaluation assessed which patients with a second hip fracture could benefit most from an exoskeleton preventing falls and whether its development is feasible. Methods The life-course of hip fractured patients presenting with dementia or cardiovascular diseases was simulated using a Markov model relying on the United Kingdom administrative data and complemented by published literature. A group of experts provided the exoskeleton parameters. Secondary analyses included a threshold analysis to identify the exoskeleton requirements (e.g. minimum impact of the exoskeleton on patients’ quality of life) leading to a reimbursable incremental cost-effectiveness ratio. Similarly, the uncertainty around these requirements was modelled by varying their standard errors and represented alongside population Expected Value of Perfect Information (EVPI). Results Our base-case found the exoskeleton cost-effective when providing a statistically significant reduction in SHF risk. The secondary analyses identified 286 cost-effective combinations of the exoskeleton requirements. The uncertainty around these requirements was explored producing further 22,880 scenarios, which showed that this significant reduction in SHF risk was not necessary to support the exoskeleton adoption in clinical practice. Conversely, a significant improvement in women quality of life was crucial to obtain an acceptable population EVPI regardless of the cost of the exoskeleton. Conclusions Our study identified the exoskeleton requisites to be cost-effective and the value of future research. Decision-makers could use our analyses to assess not only whether the exoskeleton could be cost-effective but also how much further research and development of the exoskeleton is worth to be pursued.

scholarly journals Variation of the Inpatient Cost of Care in the Treatment of Isolated Geriatric Intertrochanteric Hip Fractures

2020 ◽  
Vol 11 ◽  
pp. 215145932097653
Author(s):  
Kelsey Wise ◽  
Breanna L. Blaschke ◽  
Harsh R. Parikh ◽  
Tiffany Gorman ◽  
Lauren Casnovsky ◽  
...  
Keyword(s):  
Hip Fractures ◽  
Indirect Costs ◽  
Patient Characteristics ◽  
Cost Of Care ◽  
Inpatient Cost ◽  
Public Health Issue ◽  
Activity Based Costing ◽  
Linear Regression Models ◽  
Level Of Evidence ◽  
Payment Models

Introduction: Geriatric hip fractures are a major, costly public health issue, expected to increase in incidence and expense with the aging population. As healthcare transitions towards value-based care, understanding cost drivers of hip fracture treatment will be necessary to perform adequate risk adjustment. Historically, cost has been variable and difficult to determine. This study was purposed to identify variables that can predict the overall cost of care for geriatric intertrochanteric (IT) hip fractures and provide a better cost prediction to ensure the success of future bundled payment models. Methods: A retrospective review of operatively-managed geriatric hip fractures was performed at single urban level I academic trauma center between 2013 and 2017. Patient variables were collected via the electronic medical record (EMR) including CCI, ACCI, ASA, overall length of stay (LOS), AO/OTA fracture classification and demographics. Direct and indirect costs were calculated by activity-based costing by the hospital’s accounting software. Multivariable linear regression models evaluated which parameters predicted total inpatient cost of care. Results: The mean cost of care was $19,822, ranging from $9,128 to $64,211. Critical care comprised 16.9% of total costs, followed by implant costs (13.6%), and nursing costs (12.6%). Regression analysis identified both ASA ( p < 0.01) and ACCI ( p = 0.01) as statistically significant associative parameters, but only LOS ( r 2 = 0.77) as a strong correlative measure for inpatient care cost. Conclusion: This study found no correlation between ACCI or ASA and the total inpatient cost of care in isolated intertrochanteric geriatric hip fractures, suggesting that the inpatient episode-of-care costs cannot be accurately predicted by the patient demographics/comorbidities alone. Future bundled care payment models would have to be adjusted to account for variables beyond just patient characteristics. Level of Evidence: Diagnostic Level IV.

scholarly journals Improving Hip Fracture Care in Ireland: A Preliminary Report of the Irish Hip Fracture Database

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Prasad Ellanti ◽  
Breda Cushen ◽  
Adam Galbraith ◽  
Louise Brent ◽  
Conor Hurson ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Preliminary Report ◽  
Older Persons ◽  
International Standards ◽  
Standards Of Care ◽  
Age Group ◽  
Web Based ◽  
Fracture Care ◽  
Orthopaedic Ward

Introduction. Hip fractures are common injuries in the older persons, with significant associated morbidity and mortality. The Irish Hip Fracture Database (IHFD) was implemented to monitor standards of care against international standards.Methods. The IHFD is a clinically led web-based audit. We summarize the data collected on hip fractures from April 2012 to March 2013 from 8 centres.Results. There were 843 patients with the majority being (70%) female. The 80–89-year age group accounted for the majority of fractures (44%). Most (71%) sustained a fall at home. Intertrochanteric fractures (40%) were most common. Only 28% were admitted to an orthopaedic ward within 4 hours. The majority (97%) underwent surgery with 44% having surgery within 36 hours. Medical optimization (35%) and lack of theatre space (26%) accounted for most of the surgical delay. While 29% were discharged home, 33% were discharged to a nursing home or other long-stay facilities. There was a 4% in-hospital mortality rate.Conclusions. Several key areas in both the database and aspects of patient care needing improvement have been highlighted. The implementation of similar databases has led to improved hip fracture care in other countries and we believe this can be replicated in Ireland.

Measuring cost savings of process improvement.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 196-196
Author(s):  
Alexis Barboza ◽  
Elizabeth Rebello ◽  
Heidi Wied Albright ◽  
Johnny Dang ◽  
Jennifer Jones ◽  
...  
Keyword(s):  
Process Improvement ◽  
Planning Process ◽  
Cost Savings ◽  
Bone Marrow Aspiration ◽  
Cancer Center ◽  
Process Mapping ◽  
Activity Based Costing ◽  
Process Improvements ◽  
Anesthesia Providers ◽  
The Cost

196 Background: The aim of the project was to use anesthesia providers in a cancer center to lead process improvements using time-driven activity-based costing (TDABC), a system of measuring process and capacity costs. Methods: The process improvement objectives were centered on eliminating unnecessary patient care processes and improving patient flow. Teams were tasked with planning, process mapping, improving processes, and measuring costs. Projects were done in four anesthesia sites: ambulatory surgery, bone marrow aspiration, pediatric CT and XRT, and cardiopulmonary areas. Results: Process mapping identified areas for improvement and costs before and after the improvement. The Table highlights four project areas’ average total cost and time savings per patient using TDABC methodology. Conclusions: TDABC is a costing methodology that measures the costs of care utilizing process maps. Anesthesia providers had front-line insight in improving process flow and found the process mapping useful to improve processes and measure the cost savings of the improvement. In each area there was improvement or no adverse effect on patient outcomes. This project demonstrates that TDABC illustrates inefficiencies and provides a method to evaluate the cost savings of process improvements. As cancer care reimbursement evolves, the ability to control costs while providing value-based care is essential. [Table: see text]

scholarly journals Key Service Improvements After the Introduction of an Integrated Orthogeriatric Service

2019 ◽  
Vol 10 ◽  
pp. 215145931989389 ◽  
Author(s):  
R. P. Murphy ◽  
C. Reddin ◽  
E. P. Murphy ◽  
R. Waters ◽  
C. G. Murphy ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hip Fractures ◽  
Performance Indicators ◽  
Functional Outcomes ◽  
Best Practice ◽  
Standards Of Care ◽  
Fracture Care ◽  
Best Practice Guidelines ◽  
Improve Compliance

Introduction: Models of orthogeriatric care have been shown to improve functional outcomes for patients after hip fractures and can improve compliance with best practice guidelines for hip fracture care. Methods: We evaluated improvements to key performance indicators in hip fracture care after implementation of a formal orthogeriatric service. Compliance with Irish Hip Fracture standards of care was reviewed, and additional outcomes such as length of stay, access to rehabilitation, and discharge destination were evaluated. Results: Improvements were observed in all of the hip fracture standards of care. Mean length of stay decreased from 19 to 15.5 days (mean difference 3.5 days; P < .05). A higher proportion of patients were admitted to rehabilitation (16.7% vs 7.9%, P < .05), and this happened in a timelier fashion (17.8 vs 24.8 days, P < .05). We found that less patients required convalescence post-hip fracture. Discussion: A standardized approach to integrated post-hip fracture care with orthogeriatrics has improved standards of care for patients. Conclusion: Introduction of orthogeriatric services has resulted in meaningful improvements in clinical outcomes for older people with hip fractures.

scholarly journals 65 Fragility Fracture Network (FFN) Malaysia - A Call to Action for Better Outcome in Malaysia

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv13-iv17
Author(s):  
Hui Min Khor ◽  
Joon Kiong Lee ◽  
Alan Swee Hock Ch'ng ◽  
Hong Khoh ◽  
Lawrence Lee ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Fragility Fracture ◽  
Care Pathway ◽  
Fragility Fractures ◽  
Fracture Network ◽  
Asia Pacific ◽  
Secondary Fracture ◽  
Fracture Care ◽  
Rate Of Increase

Abstract Introduction The incidences of hip fractures are increasing worldwide and over 50% of all hip fractures are projected to occur in Asia. Malaysia is predicted to have the highest rate of increase in numbers of hip fracture in Asia Pacific by 2050. Despite the health and economic burden associated with fragility fractures, there is limited systematic guidance or nationwide interventions set up to address this foreseeable tsunami in Malaysia. This has called for the formation of a national Fragility Fracture Network to bring together experts from different disciplines nationally to drive policy change and improve quality of care in patients with fragility fracture. Method The Asia Pacific Regional Fragility Fracture Summit held in Singapore in May 2018 brought together representatives of regional societies from geriatrics, orthopedic, osteoporosis and rehabilitation to share key challenges in providing optimal fragility fracture care. Three clinicians from Malaysia representing three different societies in Asia Pacific who attended the summit initiated the idea of forming a national multidisciplinary network to focus on improving acute hip fracture care, post-acute care rehabilitation and secondary fracture prevention. Results After the first meeting held in June 2018 with only 4 members in Kuala Lumpur, the network has expanded to include members from 7 different states in Malaysia. This has led to the formation of the Fragility Fracture Network (FFN) Malaysia in August 2018. The key goals of the network include the development of clinical hip fracture care pathway, initiating national hip fracture registry and fracture liaison service. Conclusion FFN Malaysia serves as a platform to unite healthcare providers and policy makers in prioritizing and having co-ownership in improving fragility fracture care in the country.

scholarly journals Textbook process as a composite quality indicator for in-hospital hip fracture care

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Stijn C. Voeten ◽  
◽  
Michel W. J. M. Wouters ◽  
Franka S. Würdemann ◽  
Pieta Krijnen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Hip Fracture ◽  
Hospital Stay ◽  
Quality Indicator ◽  
Hospital Level ◽  
Fracture Care ◽  
Process Indicator ◽  
Patient Level ◽  
Hospital Variation ◽  
Process Compliance

Abstract Summary Individual process indicators often do not enable the benchmarking of hospitals and often lack an association with outcomes of care. The composite hip fracture process indicator, textbook process, might be a tool to detect hospital variation and is associated with better outcomes during hospital stay. Purpose The aim of this study was to determine hospital variation in quality of hip fracture care using a composite process indicator (textbook process) and to evaluate at patient level whether fulfilment of the textbook process indicator was associated with better outcomes during hospital stay. Methods Hip fracture patients aged 70 and older operated in five hospitals between 1 January 2018 and 31 December 2018 were included. Textbook process for hip fracture care was defined as follows: (1) assessment of malnutrition (2) surgery within 24 h, (3) orthogeriatric management during admission and (4) operation by an orthopaedic trauma certified surgeon. Hospital variation analysis was done by computing an observed/expected ratio (O/E ratio) for textbook process at hospital level. The expected ratios were derived from a multivariable logistic regression analysis including all relevant case-mix variables. The association between textbook process compliance and in-hospital complications and prolonged hospital stay was determined at patient level in a multivariable logistic regression model, with correction for patient, treatment and hospital characteristics. In-hospital complications were anaemia, delirium, pneumonia, urinary tract infection, in-hospital fall, heart failure, renal insufficiency, pulmonary embolism, wound infection and pressure ulcer. Results Of the 1371 included patients, 753 (55%) received care according to textbook process. At hospital level, the textbook compliance rates ranged from 38 to 76%. At patient level, textbook process compliance was significantly associated with fewer complications (38% versus 46%) (OR 0.66, 95% CI 0.52–0.84), but not with hospital stay (median length of hospital stay was 5 days in both groups) (OR 1.01, 95% CI 0.78–1.30). Conclusion The textbook process indicator for hip fracture care might be a tool to detect hospital variation. At patient level, this quality indicator is associated with fewer complications during hospital stay.

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