Use of Risk-Adjusted Outcome Measures to Determine Cost-Effectiveness and Reduce Variation of Care Using a Practice Guideline for Children with Asthma

Abstract

The objective of this article is to measure risk-adjusted outcomes following the introduction of a pediatric practice guideline for the care of asthma. This includes a measurement of outcome variables that were identified during design of a pediatric practice guideline (PPG) for the treatment of asthma in hospitalized pediatric patients: one historical control group off the PPG (PPGOff/h, n = 116), and two concurrent groups of patients (PPGOn/c, n = 100, and PPGOff/c, n = 66) treated at Texas Children's Hospital, a stand-alone, medical school-based teaching hospital. This includes the use of a physician-coordinated practice guideline with multidisciplinary input that is part of the medical record, and functions as an order set to guide care by both physicians and support staff. The main outcome is the effect of a pediatrie practice guideline upon risk-adjusted outcome variables measuring quality of care, health status, and utilization of resources. The practice guideline was used in 63.7% of the concurrent patients. There were significant differences between the concurrent groups of patients (PPGOn/c and PPGOff/c) regarding resource utilization. Seventy-five percent in the PPGOn/c group were discharged by 2 days versus 51.5% of the PPGOff/c group (p < 0.008). A mean difference of $1,307.00 was found between the PPGOn/c group and the PPGOff/c group. This was highly significant (p < 0.0001), and included savings in both direct and indirect and fixed and variable costs. The largest impact upon variable costs were seen in those pertaining to the pharmacy (p = 0.037). There were no differences found in any of the parameters used for estimation of risk (severity of illness, demographics, etc.) among the three groups. There were also no differences between the groups regarding those measures of quality of care or health status, except in the area of teaching. There was a significant difference in the amount of teaching given to the parents/patients regarding the patient's illness. In the PPGOn/c group, teaching was accomplished in 92% of the cases, compared to only 3% of the patients in the PPGOff/c group (p = 0.001). A practice guideline with risk adjusted-outcome measures can be used to ensure that quality of care and health status of patients are maintained while achieving significant savings in terms of healthcare resources. Additionally, the practice guideline can improve the ability of the healthcare providers to meet the educational goals of parent and patient teaching.