"ProvenCareSM" a provider-driven pay-for-performance program for acute episodic cardiac surgical core
"ProvenCareSM" a provider-driven pay-for-performance program for acute episodic cardiac surgical core
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DOI：
10.1097/sla.0b013e318155a996
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发表时间：
2007-10-01
影响因子：
9
通讯作者：
Steele, Glenn D., Jr.
中科院分区：
文献类型：
--
作者：
Casale, Alfred S.;Paulus, Ronald A.;Steele, Glenn D., Jr.
目的：为了测试一个集成的交付系统是否可以成功地实施基于证据的按绩效付费计划的冠状动脉旁路移植术（CABG）surgery. Methods：该计划包括3个组成部分：（1）建立可实施的最佳实践;（2）开发基于风险的定价;（3）建立一个机制，患者参与。外科医生审查了所有I类和IIa类"2004年美国心脏协会/美国心脏病学会CABG手术指南"，并将其转化为40种可验证的行为。这些被嵌入到一个新的ProvenCare（SM）程序中，并在电子健康记录系统中“硬连线”，包括订单集、模板和“超时”。同时将术前、住院和术后90天内的护理打包成一个固定价格。制定了患者契约，以强调患者激活的重要性。2006年2月2日至2007年2月2日期间接受治疗的所有择期CABG患者均纳入（ProvenCare（SM）组），并与2005年接受治疗的137例患者（常规护理组）进行比较。在3个月时，计划合规性达到100%，但在接下来的3个月内短暂下降至86%。可靠性随后增加到100%，并在研究期间的剩余时间内持续。可靠性的总体趋势在P = 0.001时具有显著性。30天临床结局显示改善趋势（表1），但只有出院回家的可能性达到统计学显著性。住院时间减少了16%，平均住院费用下降了5.2%。结论：由电子健康记录系统支持的冠状动脉旁路移植术提供者驱动的按绩效付费流程可以可靠地提供循证护理，从根本上改变报销激励，并可能最终改善结果并减少资源使用。
Objective: To test whether an integrated delivery system could successfully implement an evidence-based pay-for-performance program for coronary artery bypass graft (CABG) surgery.Methods: The program consisted of 3 components: (1) establishing implementable best practices; (2) developing risk-based pricing; (3) establishing a mechanism for patient engagement. Surgeons reviewed all class I and IIa "2004 American Heart Association/ American College of Cardiology Guidelines for CABG Surgery" and translated them into 40 verifiable behaviors. These were imbedded within a new ProvenCare(SM) program and "hardwired" within the electronic health record system, including order sets, templates, and "time outs". Concurrently preoperative, inpatient, and postoperative care within 90 days was packaged into a fixed price. A Patient Compact was developed to highlight the importance of patient activation. All elective CABG patients treated between February 2, 2006 and February 2, 2007 were included (ProvenCare(SM) Group) and compared with 137 patients treated in 2005 (Conventional Care Group).Results: Initially, only 59% of patients received all 40 best practice components. At 3 months, program compliance reached 100%, but fell transiently to 86% over the next 3 months. Reliability subsequently increased to 100% and was sustained for the remainder of the study period. The overall trend in reliability was significant at P = 0.001. Thirty-day clinical outcomes showed improved trends (Table 1) but only the likelihood of discharge to home reached statistical significance. Length of stay decreased by 16% and mean hospital charges fell 5.2%.Conclusion: A provider-driven pay-for-performance process for CABG, enabled by an electronic health record system, can reliably deliver evidence-based care, fundamentally alter reimbursement incentives, and may ultimately improve outcomes and reduce resource use.