From Volume to Value in Health Care - 《大发娱乐》 编辑
听播客 with University of Utah CEO Vivian 李 and health care strategeist Michael E. 行李搬运工人
(SALT LAKE CITY) - Bucking national trends, a new study suggests that a program could be making a difference in healthcare quality and cost. 开发的 犹他大学医疗保健中心 (UUHC), the 价值驱动的结果 (VDO) program breaks down health procedure costs to the level of each bandage and minutes of nursing time, revealing variabilities that are otherwise hidden from view. After a multidisciplinary care team addressed inefficiencies in three common procedures - joint replacement, 院内实验室检测, and sepsis management – VDO showed that patients fared better and costs in some areas fell by about 10 percent. The results were published online in the 美国医学杂志 协会(《大发娱乐》) 9月. 13.
"The transition of health care from volume to value is no longer theoretical, 或是一厢情愿的想法,他说： 伴随的社论 written by health care transformation leaders, Michael E. 波特,Ph值.D., a Harvard Business School strategist, and Thomas 李米.D., M.Sc., chief medical officer for Press Ganey Associates. "This article shows that achieving better quality and lower costs is possible, and everyone can benefit: patients, 医院和医生, 和社会."
"In order to provide higher value care, we need to better understand our costs,首席作者Vivian S. 李米.D., Ph.D., M.B.A., senior vice president at University of Utah Health Sciences and CEO of UUHC, which has 1.7 million patient visits each year. "We're making the case that an organization can quantify and manage value, and that's going to be a huge part in improving the health care system."
A case in point: knee and hip replacements, which - along with the likes extensive burns, 剖腹产手术, and drug and alcohol abuse - was placed on a list of 19 procedures with the highest total direct costs. 鉴于这种, along with the relative standardized nature of joint replacement surgery and quality efforts already underway with joint replacement providers, the VDO tool offered an ideal opportunity to assist the team in further care process improvements.
The team of multidisciplinary Joint Replacement clinicians met and identified key care pathway improvements that would likely have an impact on the time a patient spends in the hospital (length of stay), the quality of care the patient received, the cost of care and even the cost of implants. 使用VDO工具, they identified cost and locally and nationally defined quality metrics, 被称为“完美护理指数”, and followed the index to determine if the clinical pathway improvements were making a difference.
例如, the team found that a certain percentage of patients were not meeting Perfect Care because they were not up and out of bed on the day of surgery, a locally defined quality metric. One commonality was that these cases occurred late in the day, after physical therapists shifts ended. After adjusting the therapists' shifts they achieved 100% compliance with Perfect Care for that measure, and saw that it was a significant predictor of length of stay and reduced cost. Simple changes like this one, and negotiating improved pricing for implants, showed improvements. Length of stay decreased from 3.5 to 2.9, and costs decreased by approximately 10 percent.
"We were able to get a macro-level view of where the opportunities for improvement were,资深作者说 罗伯特·彭德尔顿，M.D.首席医疗质量办公室在uhc. "The case studies were driven by doctors having insights and having data available."
Two additional, common procedures saw similar changes. In the case of in-hospital lab testing for acutely ill patients, it was found that some health care providers were ordering unnecessary tests. An education campaign and other measures drove down superfluous testing, decreasing mean costs from $138 to $123, 或者10%, 每天. In a pilot project for management of sepsis, one of the top three killers in hospitals, raising awareness of warning signs contributed to a shortened mean time to administering potentially life-saving antibiotics, 从7.8 to 3.6个小时.
"We have great data, but this is just the beginning," says Pendleton. The program is expanding to optimize other procedures, and new versions of VDO are factoring in additional measurements such as patient reported outcomes that take into account the patient's own point of view of how well they are doing.
"I feel like by the time I retire I'm going to think, 我的天哪, how could we have not even been thinking about value and quality back then? It's hard to imagine,'" says 李.
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"Implementation of a Value-Driven Outcomes Program to Identify High Variability in Clinical Costs and Outcomes: Association With Reduced Cost and Improved Quality发表于 《大发娱乐》 9月上线. 13, 2016
该研究的作者是Vivian S. 李, Kensaku川, 雷切尔赫斯, 查尔顿公园, Jeffrey Young, 谢利猎人, 史蒂夫·约翰逊, 桑迪Gulbransen, 克里斯托弗·E. 德文·J·佩尔特. 霍顿，肯尼·K. 汤姆·格雷夫斯. Greene, Yoshimi Anzai, and Robert C. Pendleton all from 犹他大学医疗保健中心.