Variation in Surgeon-Level Intraoperative Costs: An Intervention Study

外科医生水平的术中费用的变化：一项干预研究

• 批准号: 9349348
• 负责人: Christopher Childers
• 金额: $ 6.7万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9349348
• 关键词: Variation; Surgeon; Level; Intraoperative; Costs

Project Summary The growth of national health care expenditures is unsustainable, reaching a staggering $2.9 trillion in 2013 (8). Surgical expenditures are estimated to account for 29% of costs and consume 1/14th of our nation's Gross Domestic Product (GDP) by 2025 (2, 3). Time in the operating room is extremely costly, with estimates as high as $100 per minute(4). Surgical supplies alone represent up to 50% of operating room expenses(14). Historically, there has been little incentive to contain costs, but with the introduction of the Affordable Care Act (ACA), reimbursements are now linked to a diagnosis or a procedure, rather than individual components of a patient's care(10). This shifts the burden of reducing expenses to health care providers who must now deliver high quality care on a fixed income. The Agency for Healthcare Research and Quality (AHRQ), in particular, has an interest in evaluating, optimizing, and delivering valuable healthcare under this new framework. Surgeons have a direct impact on the cost of a patient's care as they pre-select items used for cases and open additional instruments as the operation progresses. It is common for a single surgical implant to cost thousands of dollars. Despite this, research describing intraoperative expenses is rare (16). This proposal seeks to remedy this information gap by (I) calculating surgeon-specific intraoperative costs for common general surgery operations across several academic hospitals, (II) identifying factors that drive these expenses, and (III) developing and implementing an intervention aimed to reduce these expenses. This project will retrospectively analyze electronic medical record (EMR) and hospital accounting data to determine average surgeon-expenditures for several common operations across multiple institutions. Multiple logistic regression analysis will identify the impact of patient and surgeon factors on costs. Semi-structured interviews of focus groups will shape development of the intervention. This will be followed by a six-month implementation phase and prospective analysis of the intervention's efficacy and feasibility. Results of this study will inform hospitals and health care systems about the relative costs of items used in their operating rooms and the factors driving these expenses. Importantly, it will introduce a methodology for institutions to analyze their own expenses and provide a generalizable, structured intervention that can be adapted for their use.

项目摘要 国家医疗保健支出的增长是不可持续的，2013年达到惊人的2.9万亿美元 （八）、据估计，手术费用占成本的29%，占我国总收入的1/14 到2025年国内生产总值（GDP）（2，3）。在手术室的时间是非常昂贵的，估计高达 每分钟100美元（4）。仅手术用品就占手术室费用的50%（14）。 从历史上看，控制成本的动机很少，但随着《平价医疗法案》的出台， (ACA)，报销现在与诊断或程序挂钩，而不是与 病人的护理（10）这将减少开支的负担转移到现在必须提供服务的医疗保健提供者身上 高质量的医疗服务。特别是医疗保健研究和质量机构（AHRQ）， 有兴趣在这个新框架下评估，优化和提供有价值的医疗保健。 外科医生对病人的护理成本有直接影响，因为他们预先选择用于病例的物品， 随着手术的进展，增加了手术工具。一个外科植入物的成本 数千美元。尽管如此，描述术中费用的研究很少（16）。这项建议 试图通过以下方式弥补这一信息差距：（I）计算外科医生特定的术中成本， 在几个学术医院的普通外科手术，（二）确定驱动这些因素， （三）制定和实施旨在减少这些费用的干预措施。这个项目 将回顾性分析电子病历（EMR）和医院会计数据，以确定 跨多个机构的几个常见操作的平均外科手术支出。多元logistic 回归分析将确定患者和外科医生因素对成本的影响。半结构式访谈 焦点小组的参与将决定干预措施的发展。随后将进行为期六个月的 实施阶段和干预措施的有效性和可行性的前瞻性分析。成果 这项研究将告知医院和医疗保健系统在其运作中使用的项目的相对成本， 房间和驱动这些费用的因素。重要的是，它将为机构引入一种方法， 分析他们自己的费用，并提供一个可推广的，结构化的干预，可以适应他们的 使用.