Return on Investment for Quality Improvement Collaboratives in Surgery

外科质量改进合作机构的投资回报

• 批准号: 8050146
• 负责人: NANCY J BIRKMEYER
• 金额: $ 28.35万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2013-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8050146
• 关键词: Return; Investment; Quality; Improvement; Collaboratives

DESCRIPTION (provided by the applicant): Motivated by wide variation in patient outcomes, payers have implemented a broad range of initiatives aimed at improving the quality of surgical care. Common strategies include centers of excellence programs that steer patients to hospitals likely to have superior outcomes and pay-for- performance plans, which reward hospitals for compliance with targeted processes of care. Recently, several large payers have begun funding state- or regional level quality improvement (QI) collaboratives. While their details vary, these efforts generally involve collecting detailed clinical data regarding process and outcomes, regular feedback on provider performance, and explicit mechanisms for quality improvement. Early results from these large QI collaboratives indicate their potential to substantially improve patient outcomes. Nonetheless, wide dissemination of this model remains limited due to the high costs associated with data collection and program coordination which range from $50 to $200 per patient. However, many believe that savings associated with quality improvement may more than offset such costs. By some estimates, surgical complications add over $11,000 to the average payments for inpatient surgical procedures, most of which is passed on to payers. Wide variation in hospital payments further suggests opportunities for savings. Based on our pilot studies using claims from one large payer in Michigan, average total payments for CABG and other common procedures vary by more than $5,000 across hospitals, after accounting for contractual price differences. A large proportion of this variation is attributable to differences in non-bundled specialty services during the index admission and in 30-day readmission rates. If such variation could be reduced only moderately, quality improvement would not only cover its costs, but also substantially reduce the overall costs of surgical care. In exploring the financial implications of large QI collaboratives in surgery, we will examine data from the Value Partnership Program of Blue Cross and Blue Shield of Michigan (BCBSM), the most ambitious program of its type to date. This program involves more than 40 hospitals statewide, enrolls almost 50,000 patients annually, and costs over $10 million each year to administer. Its clinical scope is broad, including bariatric, cardiac, general, and vascular surgery, as well as percutaneous coronary and peripheral arterial interventions, thus providing a rich substrate for examining the relationship between quality improvement and costs. Aiming to improve quality and reduce costs associated with surgical care, many large payers and states are investing heavily in large-scale clinical outcomes registries and quality improvement programs. Examining the largest of these efforts, based in Michigan, this project will assess relationships between hospital quality and costs and the return on investment of collaborative quality improvement.

描述(由申请人提供)：由于患者结果的巨大差异，付款人已经实施了一系列旨在提高手术护理质量的倡议。常见的战略包括卓越中心计划，将患者引导到可能具有更好结果的医院，以及按绩效支付计划，奖励遵守有针对性的护理过程的医院。最近，几个大的支付者已经开始资助州或地区层面的质量改进(QI)合作。虽然它们的细节各不相同，但这些努力通常涉及收集关于过程和结果的详细临床数据、关于提供者表现的定期反馈以及明确的质量改进机制。这些大型QI协作的早期结果表明，它们有可能显著改善患者的预后。尽管如此，这种模式的广泛传播仍然有限，因为与数据收集和项目协调相关的高成本从每个患者50美元到200美元不等。然而，许多人认为，与质量改进相关的节省可能会抵消这些成本。根据一些估计，手术并发症使住院外科手术的平均费用增加了1.1万美元，其中大部分转嫁给了付款人。医院支付的差异很大，这进一步表明了节省的机会。根据我们使用密歇根州一家大付款人的索赔进行的试点研究，在考虑了合同价格差异后，CABG和其他常见程序的平均总付款在不同医院之间相差超过5000美元。这一差异的很大一部分是由于在指数录取期间非捆绑专科服务和30天再住院率的差异。如果这种差异仅能适度减少，质量改进将不仅弥补其成本，还将大幅降低手术护理的整体成本。在探索大型QI合作在外科手术中的财务影响时，我们将研究来自密歇根蓝十字和蓝盾(BCBSM)的价值合作计划(BCBSM)的数据，这是迄今为止同类计划中最雄心勃勃的计划。该计划涉及全州40多家医院，每年招收近5万名患者，每年的管理费用超过1000万美元。它的临床范围很广，包括减肥、心脏、全身和血管手术，以及经皮冠状动脉和外周动脉介入治疗，因此为研究质量改进和成本之间的关系提供了丰富的底物。为了提高质量和降低与手术护理相关的成本，许多大的支付者和州正在大规模的临床结果登记和质量改进计划上投入巨资。这个项目考察了密歇根州最大的这些努力，将评估医院质量和成本之间的关系，以及协作性质量改进的投资回报。