Nationwide Outcomes Measurement in Colorectal Cancer Surgery: Improving Quality and Reducing Costs

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• 作者：Johannes A. Govaert ; MD^a ; ^d ; ^{j.a.govaert@lumc.nl" class="auth_mail" title="E-mail the corresponding author} ; Wouter A. van Dijk ; MSc^e ; ^f ; Marta Fiocco ; PhD^b ; ^c ; Alexander C. Scheffer ; MSc^e ; Lieke Gietelink ; MD^a ; Michel W.J.M. Wouters ; MD ; PhD^a ; ^g ; Rob A.E.M. Tollenaar ; MD ; PhD^a
• 关键词：ASA ; American Society of Anesthesiologists classification ; DSCA ; Dutch Surgical Colorectal Audit ; OR ; odds ratio ; Q1 ; first 90 days after discharge ; R ; correlation coefficient ; RD ; relative difference
• 刊名：Journal of the American College of Surgeons
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：222
• 期：1
• 页码：19-29.e2
• 全文大小：1053 K

文摘

Recent literature suggests that focus in health care should shift from reducing costs to improving quality; where quality of health care improves, cost reduction will follow. Our primary aim was to investigate whether improving the quality of surgical colorectal cancer care, by using a national quality improvement initiative, leads to a reduction of hospital costs.

Study Design

This was a retrospective analysis of clinical and financial outcomes after colorectal cancer surgery in 29 Dutch hospitals (9,913 patients). Detailed clinical data were obtained from the 2010 to 2012 population-based Dutch Surgical Colorectal Audit. Patient-level costs were measured uniformly in all participating hospitals and based on time-driven, activity-based costing. Odds ratios (OR) and relative differences (RD) were risk adjusted for hospitals and differences in patient characteristics.

Results

Over 3 consecutive years, severe complications and mortality declined by 20% (risk-adjusted OR 0.739, 95% CI 0.653 to 0.836, p < 0.001), and 29% (risk-adjusted OR 0.757, 95% CI 0.571 to 1.003, p = 0.05), respectively. Simultaneously, costs during primary admission decreased 9% (risk-adjusted RD −7%, 95% CI −10% to −5%, p < 0.001) without an increase in costs within the first 90 days after discharge (RD −2%, 95% CI −10% to 6%, p = 0.65). An inverse relationship (at hospital level) between severe complication rate and hospital costs was identified (R = 0.64). Hospitals with increasing severe complication rates (between 2010 and 2012) were associated with increasing costs; hospitals with declining severe complication rates were associated with cost reduction.

Conclusions

This report presents evidence for simultaneous quality improvement and cost reduction. Participation in a nationwide quality improvement initiative with continuous quality measurement and benchmarked feedback reveals opportunities for targeted improvements, bringing the medical field forward in improving value of health care delivery. The focus of health care should shift to improving quality, which will catalyze costs savings as well.