Transforming Patient Value: Comparison of Hospital, Surgical, and General Surgery Patients

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• 作者：Henry A. Pitt ; MD ; FACS^a ; ^b ; ^{Henry.Pitt@tuhs.temple.edu" class="auth_mail" title="E-mail the corresponding author} ; Ella Tsypenyuk ; BS^b ; Susan L. Freeman ; MD ; MS^b ; Steven R. Carson ; RN ; BSN ; MHA^b ; Jonathan A. Shinefeld ; RN ; MEd ; CPHQ^b ; Sally M. Hinkle ; DNP ; MPA ; RN^b ; Benjamin D. Powers ; MD^a ; Amy J. Goldberg ; MD ; FACS^a ; Verdi J. DiSesa ; MD ; MBA ; FACS^a ; ^b ; Larry R. Kaiser ; MD ; FACS^a ; ^b
• 关键词：EH ; Episcopal Hospital ; FY ; fiscal year ; HCAHPS ; Hospital Consumer Assessment of Healthcare Providers and Systems ; LOS ; length of stay ; PSI ; patient safety indicator ; Q&A ; Quality and Accountability ; STEEP ; Safety ; Timeliness ; Effectiveness ; Efficiency ; Equity ; Patient Centeredness ; TUH ; Temple University Hospital ; UHC ; University HealthSystem Consortium
• 刊名：Journal of the American College of Surgeons
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：222
• 期：4
• 页码：568-575
• 全文大小：461 K

文摘

Patient value (V) is enhanced when quality (Q) is increased and cost (C) is diminished (V = Q/C). However, calculating value has been inhibited by a lack of risk-adjusted cost data. The aim of this analysis was to measure patient value before and after implementation of quality improvement and cost reduction programs.

Study Design

Multidisciplinary efforts to improve patient value were initiated at a safety-net hospital in 2012. Quality improvement focused on adoption of multiple best practices, and minimizing practice variation was the strategy to control cost. University HealthSystem Consortium (UHC) risk-adjusted quality (patient mortality + safety + satisfaction + effectiveness) and cost (length of stay + direct cost) data were used to calculate patient value over 3 fiscal years. Normalized ranks in the UHC Quality and Accountability Scorecard were used in the value equation.

Results

For all hospital patients, quality scores improved from 50.3 to 66.5, with most of the change occurring in decreased mortality. Similar trends were observed for all surgery patients (42.6 to 48.4) and for general surgery patients (30.9 to 64.6). For all hospital patients, cost scores improved from 71.0 to 2.9. Similar changes were noted for all surgical (71.6 to 27.1) and general surgery (85.7 to 23.0) patients. Therefore, value increased more than 30-fold for all patients, 3-fold for all surgical patients, and almost 8-fold for general surgery patients.

Conclusions

Multidisciplinary quality and cost efforts resulted in significant improvements in value for all hospitalized patients as well as general surgery patients. Mortality improved the most in general surgery patients, and satisfaction was highest among surgical patients.