THE COST DRIVERS OF CARE: A PROVINCIAL CARDIAC REGISTRY-BASED COSTING ANALYSIS

Abstract

Part of the Ontario Ministry of Health and Long-Term Care funding reform is to align evidence-informed, high quality patient care with funding through quality based procedures (QBPs) defined by clusters of patients with clinically-related diagnoses or treatments. To meet the Ministry’s requirements, an evidence-based funding model needs to be developed for Cardiac QBP. The required model needs to include crucial factors related to best practice and impact on funding. The purpose of this costing analysis is to support the QBP funding model that will account for patient complexity and eventually for adherence to best practices. We did a costing analysis using Ontario Case Costing Initiative (OCCI) data linked with Cardiac Care Network of Ontario (CCN) Cardiac Registry to derive a costing model that accounted for pathway of care and co-morbidities. FY 2012-13 data from 6 Ontario advanced cardiac centres with single CCN Wait List Entry IDs linked with either inpatient or outpatient encounter were kept for analysis. The OCCI total cost was used to identify the crucial factors on costing for cardiac catheterization (cath-only), PCI, or isolated CABG (iCABG) surgery. The table below shows some clinical factors with significant impact on costs of cath-only, PCI, and iCABG procedures. In cath-only and PCI subgroups, cases with IABP or in cardiogenic shock had the highest mean and median costs; while for the iCABG subgroup, cases with CHF and creatinine>140 μmol/L had the highest mean and median costs. Covariates identified through univariate analysis were input into the multivariate models, which showed that parameters such as the pathway of care (i.e., STEMI, and NSTEMI/UA), creatinine>140 μmol/L, and CHF remained independently associated with cost increase. LVEF<50%, cardiogenic shock, IABP, COPD, and anticoagulant increased the costs for cath and PCI. Higher costs for PCI and iCABG were associated with patients 65 years or older. The analysis identified the pathway of care and patient complexities which had significant impact on costs of advanced cardiac procedures. The results provided a costing framework for determination of the Cardiac QBP funding model.