Return on Investment for Quality Improvement Collaboratives in Surgery

描述（由申请人提供）：由于患者结果的差异很大，支付方实施了一系列旨在提高手术护理质量的举措。常见的策略包括卓越中心项目，引导患者到可能有更好结果的医院，以及绩效付费计划，奖励遵守目标护理流程的医院。最近，一些大的支付者已经开始资助州或地区级别的质量改进（QI）合作。虽然他们的细节各不相同，但这些努力通常包括收集有关过程和结果的详细临床数据，对提供者绩效的定期反馈，以及明确的质量改进机制。这些大型QI合作项目的早期结果表明，它们具有显著改善患者预后的潜力。尽管如此，由于与数据收集和项目协调相关的高成本（每位患者50至200美元），这种模式的广泛传播仍然受到限制。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。据估计，手术并发症使住院外科手术的平均费用增加了1.1万美元以上，其中大部分转嫁给了付款人。医院支付的巨大差异进一步表明了节约的机会。根据我们对密歇根州一家大型付款人的索赔进行的试点研究，在考虑合同价格差异后，各医院对CABG和其他常见手术的平均总付款相差超过5,000美元。这种差异的很大一部分可归因于指数入院期间非捆绑专业服务和30天再入院率的差异。如果这种差异可以适度减少，质量的提高不仅可以弥补其成本，而且还可以大大降低手术护理的总体成本。在探索大型QI合作在外科手术中的财务影响时，我们将检查密歇根蓝十字和蓝盾价值伙伴计划（BCBSM）的数据，这是迄今为止最雄心勃勃的计划。该项目涉及全州40多家医院，每年招收近5万名患者，每年管理费用超过1000万美元。它的临床范围很广，包括减肥、心脏、一般和血管手术，以及经皮冠状动脉和外周动脉介入治疗，从而为检查质量改进与成本之间的关系提供了丰富的基础。为了提高质量和降低与外科护理相关的成本，许多大的付款人和州都在大规模的临床结果登记和质量改进项目上投入了大量资金。该项目考察了这些努力中最大的一个，总部设在密歇根州，将评估医院质量和成本之间的关系以及协作质量改进的投资回报。

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.