Deviation-based cost modeling: A novel model to evaluate the clinical and economic impact of clinical pathways
Deviation-based cost modeling: A novel model to evaluate the clinical and economic impact of clinical pathways
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DOI：
10.1016/j.jamcollsurg.2007.01.025
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发表时间：
2007-04-01
影响因子：
5.2
通讯作者：
Callery, Mark P.
中科院分区：
文献类型：
--
作者：
Vanounou, Tsafrir;Pratt, Wande;Callery, Mark P.
背景：虽然临床途径的发展是为了提高病人护理的成本效益，但很少有人进行严格的财务测试。这在今天很重要，因为付款人需要明确的解决方案来解决成本-质量难题。我们描述了一个新的，客观的，通用的模型，可以评估和连接临床途径的临床和经济影响。研究设计：对209例连续接受高急性度手术（胰十二指肠切除术）的患者实施路径前后的结果进行研究。通过合并住院时间和经过验证的并发症分类方案来定义与预期术后过程的四个等级偏差（从无到主要）。基于偏差的成本建模（DBCM）将这些偏差与实际总成本联系起来。结果：临床结果优于胰十二指肠切除术的基准标准。尽管提高了患者的视力，但这种新途径缩短了住院时间，减少了资源使用，降低了医院成本。DBCM表明，路径实施后，与预期过程的偏差较少。并发症的影响不那么严重，转化为每位患者节省了5,542美元的总成本。DBCM还显示，随着越来越多的患者迁移到我们标准化护理路径内的预期疗程，50%的总成本节省（2780美元）可归因于该路径本身，而随着时间的推移护理的改善（长期趋势）占其余部分。结论：DBCM准确地确定了临床路径实施对成本节约的增量贡献，而不仅仅是长期趋势。此外，这种多功能模型可以定制其他系统的改进，以揭示其真正的临床和经济影响。当必须将质量与成本联系起来时，这是很有价值的。[J]中华医学杂志，2007;24(4):579 -579。(C) 2007年由美国外科医师学会发布)。
BACKGROUND:Although clinical pathways were developed to streamline patient care cost efficiently, few have been put to rigorous financial test. This is important today, because payors demand clear solutions to the cost-quality puzzle. We describe a novel, objective, and versatile model that can evaluate and link the clinical and economic impacts of clinical pathways.STUDY DESIGN:Outcomes for 209 consecutive patients undergoing high-acuity surgery (pancreaticoduodenectomy), before and after pathway implementation, were examined. Four grades of deviation (none to major) from the expected postoperative course were defined by merging length of stay with a validated classification scheme for complications. Deviation-based cost modeling (DBCM) links these deviations to actual total costs.RESULTS:Clinical outcomes compared favorably with benchmark standards for pancreaticoduodenectomy. Despite increasing patient acuity, this new pathway shortened length of stay, reduced resource use, and decreased hospital costs. DBCM indicated that fewer deviations from the expected course occurred after pathway implementation. The impacts of complications were less severe and translated to an overall cost savings of $5,542 per patient. DBCM also revealed that as more patients migrated to the expected course within our standardized care path, 50% of overall cost savings ($2,780) was attributable to the pathway alone, and improvements in care over time (secular trends) accounted for the remainder.CONCLUSIONS:DBCM accurately determined the incremental contribution of clinical pathway implementation to cost savings beyond that of secular trends alone. In addition, this versatile model can be customized to other systems' improvements to reveal their true clinical and economic impacts. This is valuable when choices linking quality with cost must be made. (J Am Coll Surg 2007; 204:570-579. (C) 2007 by the American College of Surgeons).