Value-based Healthcare Delivery Research Articles

Adding value for clients during work disability assessments: A qualitative exploration from the perspective of medical examiners.

Value-based healthcare delivery focuses on optimizing care provided by measuring the healthcare outcomes which are most important to the clients relative to the total care costs. However, the understanding of what adds value for clients during work disability assessment is lacking. To explore what medical examiners (MEs) perceive as valuable during the work disability assessment process, by exploring possible: 1) facilitators, 2) barriers and 3) opportunities to add value for the client during the work disability assessment. For this explorative qualitative study, 7 semi-structured interviews were conducted with MEs in the Netherlands. Thematic coding was performed for all interviews. A large variety of facilitators (n = 22), barriers (n = 17) and opportunities (n = 11) were identified and inductively subdivided into four main themes: 1) coherent process, including all time related aspects, 2) interdisciplinary collaboration, including all aspects related to the collaboration between the ME and other professionals, 3) client-centred interaction, including all aspects related to the supportive interplay from the ME towards the client, and 4) information provision on all aspects during the work disability assessment process towards the client to ensure a valuable work disability assessment process. The overview of identified possible facilitators, barriers and opportunities to add value for clients from the perspective of the ME may stimulate improvement in the current work disability assessment practice and to better match the client needs.

276 Outpatient Versus Inpatient Laminoplasty for Cervical Spondylosis: A Non-inferiority Analysis of Surgical Outcomes

INTRODUCTION: A rising trend of outpatient spinal procedures has been observed recently due to increasing evidence of lower risk of hospital-associated risks and better value-based healthcare delivery. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for patients undergoing cervical laminoplasty for spinal spondylosis. Patients with a hospital stay of more than 48 hours were excluded from the comparative analysis to increase baseline comparability between the two groups. Patients undergoing other spinal procedures during the same hospital stay were also excluded. The outcomes of interest were postoperative complications, nonroutine discharge, readmissions, and reoperations within 30 days after surgery. The non-inferiority of outpatient compared with inpatient surgery was defined as a risk difference of <10.0% at a one-sided 97.5% confidence interval. RESULTS: A total of 808 cervical laminoplasty surgeries were identified. The study cohorts consisted of 107 and 701 patients in outpatient and inpatient groups, respectively. All recorded baseline characteristics, except age (58.3 ± 10.6 vs. 61.4 ± 11.5, p=0.01), were similar between the two groups. The incidences of postoperative complications were 2.8% and 3.4% for the outpatient and inpatient groups, respectively, while the non-routine discharge rates were 6.5% and 3.5%. Both groups had a 30-day readmission rate of 3.7%. In addition, the 30-day reoperation rates were 2.8 % and 1.4% for the outpatient and inpatient groups, respectively. Noninferiority of outpatient surgery was documented at a risk difference of 10% for postoperative complications, non-routine discharge, and readmission and reoperation rates. CONCLUSIONS: Outpatient cervical laminoplasty demonstrated similar early postoperative outcomes compared to inpatient surgery. Noninferiority in surgical outcomes after surgery was documented for outpatient compared with inpatient cervical laminoplasty surgery.

Impact of a Nationwide Medication History Sharing Program on the Care Process and End-User Experience in a Tertiary Teaching Hospital: Cohort Study and Cross-Sectional Study.

Timely and comprehensive collection of a patient's medication history in the emergency department (ED) is crucial for optimizing health care delivery. The implementation of a medication history sharing program, titled "Patient's In-home Medications at a Glance," in a tertiary teaching hospital aimed to efficiently collect and display nationwide medication histories for patients' initial hospital visits. As an evaluation was necessary to provide a balanced picture of the program, we aimed to evaluate both care process outcomes and humanistic outcomes encompassing end-user experience of physicians and pharmacists. We conducted a cohort study and a cross-sectional study to evaluate both outcomes. To evaluate the care process, we measured the time from the first ED assessment to urgent percutaneous coronary intervention (PCI) initiation from electronic health records. To assess end-user experience, we developed a 22-item questionnaire using a 5-point Likert scale, including 5 domains: information quality, system quality, service quality, user satisfaction, and intention to reuse. This questionnaire was validated and distributed to physicians and pharmacists. The Mann-Whiteny U test was used to analyze the PCI initiation time, and structural equation modeling was used to assess factors affecting end-user experience. The time from the first ED assessment to urgent PCI initiation at the ED was significantly decreased using the patient medication history program (mean rank 42.14 min vs 28.72 min; Mann-Whitney U=346; P=.03). A total of 112 physicians and pharmacists participated in the survey. Among the 5 domains, "intention to reuse" received the highest score (mean 4.77, SD 0.37), followed by "user satisfaction" (mean 4.56, SD 0.49), while "service quality" received the lowest score (mean 3.87, SD 0.79). "User satisfaction" was significantly associated with "information quality" and "intention to reuse." Timely and complete retrieval using a medication history-sharing program led to an improved care process by expediting critical decision-making in the ED, thereby contributing to value-based health care delivery in a real-world setting. The experiences of end users, including physicians and pharmacists, indicated satisfaction with the program regarding information quality and their intention to reuse.

Value-Based Healthcare Delivery: A Scoping Review.

Healthcare systems are transforming from the traditional volume-based model of healthcare to a value-based model of healthcare. Value generation in healthcare is about emphasising the health outcomes achieved by patients and organisations while maintaining an optimal relationship with costs. This scoping review aimed to identify the key elements and outcomes of implementing value-based healthcare (VBHC). The review process included studies published from 2013 to 2023 in four different databases (SpringerLink, PubMed, ProQuest and Scopus). Of the 2801 articles retrieved from the searches, 12 met the study's inclusion criteria. A total of 11 studies referred to value as the relationship between the outcomes achieved by patients and the costs of achieving those outcomes. Most of the studies highlighted the presence of leadership, the organisation of care into integrated care units, the identification and standardisation of outcome measures that generate value for the patient, and the inclusion of the patient perspective as the most prominent key elements for optimal VBHC implementation. Furthermore, some benefits were identified from VBHC implementation, which could shed light for future implementation actions. Therefore, the VBHC model is a promising approach that may contribute to an improvement in the efficiency and sustainability of healthcare.

The VALUECARE Model for value-based, integrated health and social care services delivery supported by ICT for older adults: participatory research in 6 European countries

Introduction: In 2006, Michael Porter and Elizabeth Teisberg introduced the concept of value-based health care delivery by presenting a new framework for health system design. They proposed a fundamental unifying goal for health care: maximizing value for patients. Value is defined as the health outcomes achieved in response to the needs of a patient relative to the costs of delivering these outcomes. Consequently, understanding patient goals and values is integral to delivering high value. Participatory approaches are a key element in defining the care delivery model according to the patients’ needs and contribute to the sustainability of the care delivery. This study presents the VALUECARE model co-designed with older adults, care team members, health and social service managers and ICT experts to adapt the ValueCare concept supported by technology to the community context and end-users needs.
 Target group: Older people 65 years and older with comorbidity from 6 European countries (Croatia, Ireland, Portugal, Italy, Spain & The Netherlands) facing different health challenges (cardiovascular disease, cognitive decline, frailty, and stroke).
 Participants engaged in the co-design of the value based integrated care: A total of 369 participants were involved in participatory activities with the purpose of co-designing the VALUECARE care model and supportive digital solution (n= 127 older adults, n=86 caregivers, n=109 health and social care practitioners, n=7 ICT experts, n=34 service managers, n=3 policy makers, n=3 municipality providers).
 Co-design activities implemented: Qualitative data was collected using focus groups and interviews, combining face-to-face and online means with the participants trying to adapt the methodology foreseen in the project to the pandemic situation. The eHealth Enhanced Chronic Care Model was used as a heuristic tool to integrate the discourses of the different stakeholders including older adults and those involved in the delivery of health and social care for them and featuring the guiding principles and the core elements for value-based, integrated health and social care for this group supported by ICT solutions. 
 Results: VALUECARE model highlights best practice value-based, integrated care delivery through the application of a set of 6 guiding principles for the model (i.e. quality and safety, technology as supportive tool) across 7 different key core elements (i.e. health and care decision support, comprehensive support and monitoring). Applying these principles and elements, better health outcomes and care experience for older adults are expected and an improvement in the care team wellbeing. 
 Next steps: Based on the co-design sessions, the co-designed VALUECARE model is being implemented and tested in 6 pilot sites. Continuous and periodic feedback is being collected from participants (older people and care team members) to refine the model and ensure quality care delivery, at the end of the project, a validated model of value-based and integrated care supported by technology.

How to Use Costs in Value-Based Healthcare: Learning from Real-life Examples

BackgroundHealthcare organizations measure costs for business operations but do not routinely incorporate costs in decision-making on the value of care.AimProvide guidance on how to use costs in value-based healthcare (VBHC) delivery at different levels of the healthcare system.Setting and ParticipantsIntegrated practice units (IPUs) for diabetes mellitus (DM) and for acute myocardial infarction (AMI) at the Leiden University Medical Center and a collaboration of seven breast cancer IPUs of the Santeon group, all in the Netherlands.Program Description and EvaluationVBHC aims to optimize care delivery to the patient by understanding how costs relate to outcomes. At the level of shared decision-making between patient and clinician, yearly check-up consultations for DM type I were analyzed for patient-relevant costs. In benchmarking among providers, quantities of cost drivers for breast cancer care were assessed in scorecards. In continuous learning, cost-effectiveness analysis was compared with radar chart analysis to assess the value of telemonitoring in outpatient follow-up.DiscussionCosts vary among providers in healthcare, but also between provider and patient. The joint analysis of outcomes and costs using appropriate methods helps identify and optimize the aspects of care that drive desired outcomes and value.

A Critical Review of Patient Satisfaction and Value Based Health Care

Welcome to a new horizon in healthcare where patient satisfaction is not just a goal, but the cornerstone of value-based health care delivery services. In an age where every patient is a discerning customer, doesn't it make you wonder what truly drives their satisfaction? Delving into this realm, a burgeoning number of scientific research studies are zeroing in on this very question, seeking to unveil the elements that craft a patient's healthcare journey into a fulfilling experience. This systematic study stands at the vanguard, committed to dissecting those elusive drivers that assure the quality of services aligns perfectly with patient expectations and demands. With a meticulous analytics-based approach, we aim to bridge the literature gap and illuminate the pathways that lead commercial healthcare settings towards exemplary service delivery. Join us as we explore the intricacies of patient satisfaction through the lens of the latest research, professional insights, and real-world outcomes.
 Welcome to research paper trove of insights, where meticulous research meets the art of demystifying the complex world of patient satisfaction. Have service provider ever wondered what truly lies at the heart of patient happiness within the healthcare system? Drawing on the rigor of The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) method, researcher embarked on a comprehensive review, plunging into the depths of esteemed databases like Scopus, Web of Science, and PubMed. Researcher quest spanned studies from the evolution of care in 2010 to the innovations of 2023, all penned in articulate English and filtered through stringent inclusion and exclusion criteria. From an initial wave of prospective research, we distilled our findings to an enlightened set of 50 pivotal items. With surgical precision, researcher wielded co-citation and bibliographic analysis to unearth the true gems—those factors that don't just influence patient satisfaction but redefine it, outlined by pioneering authors and monumental documents. In this blog post, we'll share our voyage through the data, classify the myriad factors impacting patient satisfaction into criterion and explanatory variables, and delve into what researchers deem essential, as well as the authentic sources of patient contentment. Join us as we unravel the most important factors that are sculpting the landscape of patient care today.

Piloting patient-reported outcome measures for evaluation of the Irish Chronic Disease Programme

Abstract Background The Irish National Integrated Care Programme for Chronic Disease (ICPCD) aims to deliver end-to-end, patient-centred care across three clinical programmes; Heart, Respiratory and Diabetes. Patient-reported outcome measures (PROMs) are a means of objectively measuring changes in patients’ subjectively-perceived health status over time in response to services. As such, PROMs facilitate service monitoring and evaluation and are an important tool for the ICPCD to ensure optimal, patient-centred, value-based healthcare delivery. Methods To select the most appropriate PROMs instrument for use across ICPCD, comprehensive literature review was undertaken followed by key stakeholder consultation in winter 2022. Following consideration against a set of pre-determined criteria the EQ-5D-5L, a well-validated, reliable PROMs instrument, was selected as the most appropriate PROMs instrument for use. Study design involved pilot implementation of EQ-5D-5L in one ICPCD ambulatory care hub service followed by mixed methods evaluation of staff experience of the pilot. Results The pilot was conducted from April to June 2023 among a socio-demographically diverse sample of patients attending their first and last episode of care with the ICPCD diabetic patient education service in Galway. Following service attendance there was a significant aggregate improvement in self-reported overall health rating but no significant change in self-reported mobility, self-care, usual activities, pain/discomfort or anxiety/depression. Predominant staff concerns included staff and patient burden and the need for adequate staff resourcing and information technology support. Conclusions In conjunction with key national stakeholders findings from the pilot will be used to support the development of a PROMs implementation plan at scale for adoption across all ICPCD services. Ultimately national implementation will support the ongoing delivery of high quality patient-centred care within ICPCD services. Key messages • PROMs facilitate service evaluation and are an important tool for the Irish National Integrated Care Programme for Chronic Disease (ICPCD) to ensure optimal patient-centred healthcare delivery. • This pilot will support PROMs implementation at scale across ICPCD services and ultimately reinforce the ongoing delivery of high-quality, value-based, integrated healthcare.

Value-Based Executive Medicine: Future Practice, Ethics, and Impact

Taking care of Very Important Persons (VIPs) has always been a contentious area of medicine. Access to private healthcare in privileged classes is often linked to socioeconomic status, and the concept role of executive health medicine has emerged. The provision of care for VIP patients requires innovative approaches to assure that their status does not influence the quality of care they receive, and this is precisely what physicians should aim for while providing Executive VIP care. This review intends to highlight the important characteristics of Executive Medicine and the future of VIP Executive Medicine operating within a Value-Based Healthcare system. We have proposed a model of value-based executive medicine in this review in an attempt to describe the basic concept of executive medicine and its various dimensions. This model is inspired by the value-based healthcare delivery framework of Michael Porter and various executive health programs offered by academic medical centers in the United States of America.

Influence of the living Pareto chart and data transparency on patient outcomes in neurosurgery.

Quality improvement (QI) tools are increasingly being used to calibrate healthcare quality. Achieving healthcare quality is essential, as there is a movement toward value-based healthcare delivery. Visual management, such as a living Pareto chart, is a strategy for improvement within the QI framework. The authors herein hypothesized that transparency of data through a living Pareto chart is a powerful way to improve patient outcomes and gain clinical efficiency. The authors retrospectively reviewed patient outcomes and complications; cerebrospinal fluid (CSF) leaks; shunt, baclofen, and other surgical site infections; readmission rates; and same- or next-day appointments in a cohort of patients at the Riley Hospital for Children from November 1, 2016, to May 31, 2020. Similarly, they reviewed neurosurgical outcomes and complications at a second institution, the Oklahoma Children's Hospital, where a living Pareto chart was utilized from February 1, 2021, to March 31, 2022. The discrete frequency and rates per month of outcomes and complications were graphed on scatterplots, Pearson correlation coefficients were calculated to measure the strength of the relationship between event frequency and time, and best-fit lines illustrated the relationship between those points through the least-squares method. At both the Riley Hospital for Children and Oklahoma Children's Hospital, the use of a living Pareto chart to display data transparently was associated with decreasing infections, and it was associated with decreasing readmissions at Riley. On the other hand, it encouraged same- or next-day clinic appointments to be offered to patients and families. Interestingly, CSF leaks were not mitigated with data transparency alone. Transparency is a driver of change in patient, provider, and institutional behaviors. It is an essential element of QI and patient safety, as well as building a culture of trust. Readmissions, infections, and same- or next-day appointments were influenced by the living Pareto chart; however, CSF leaks remained recalcitrant to data transparency. Other QI strategies may be necessary to positively affect the occurrence of CSF leaks in neurosurgery.

Outpatient versus inpatient lumbar decompression surgery: a matched noninferiority study investigating clinical and patient-reported outcomes.

Spine surgery represents an ideal target for healthcare cost reduction efforts, with outpatient surgery resulting in significant cost savings. With an increased focus on value-based healthcare delivery, lumbar decompression surgery has been increasingly performed in the outpatient setting when appropriate. The aim of this study was to compare clinical and patient-reported outcomes following outpatient and inpatient lumbar decompression surgery. The Quality Outcomes Database (QOD) was queried for patients undergoing elective one- or two-level lumbar decompression (laminectomy or laminotomy with or without discectomy) for degenerative spine disease. Patients were grouped as outpatient if they had a length of stay (LOS) < 24 hours and as inpatient if they stayed in the hospital ≥ 24 hours. Patients with ≥ 72-hour stay were excluded from the comparative analysis to increase baseline comparability between the two groups. To create two highly homogeneous groups, optimal matching was performed at a 1:1 ratio between the two groups on 38 baseline variables, including demographics, comorbidities, symptoms, patient-reported scores, indications, and operative details. Outcomes of interest were readmissions and reoperations at 30 days and 3 months after surgery, overall satisfaction, and decrease in Oswestry Disability Index (ODI), back pain, and leg pain at 3 months after surgery. Satisfaction was defined as a score of 1 or 2 in the North American Spine Society patient satisfaction index. Noninferiority of outpatient compared with inpatient surgery was defined as risk difference of < 1.5% at a one-sided 97.5% confidence interval. A total of 18,689 eligible one- and two-level decompression surgeries were identified. The matched study cohorts consisted of 5016 patients in each group. Nonroutine discharge was slightly less common in the outpatient group (0.6% vs 0.3%, p = 0.01). The 30-day readmission rates were 4.4% and 4.3% for the outpatient and inpatient groups, respectively, while the 30-day reoperation rates were 1.4% and 1.5%. The 3-month readmission rates were 6.3% for both groups, and the 3-month reoperation rates were 3.1% for the outpatient cases and 2.9% for the inpatient cases. Overall satisfaction at 3 months was 88.8% for the outpatient group and 88.4% for the inpatient group. Noninferiority of outpatient surgery was documented for readmissions, reoperations, and patient-reported satisfaction from surgery. Outpatient lumbar decompression surgery demonstrated slightly lower nonroutine discharge rates in comparison with inpatient surgery. Noninferiority in clinical outcomes at 30 days and 3 months after surgery was documented for outpatient compared with inpatient decompression surgery. Additionally, outpatient decompression surgery performed noninferiorly to inpatient surgery in achieving patient satisfaction from surgery.

Value-based Healthcare: Has the Time Come for Comprehensive Infection Care Centers?

1Fellow, Orthopaedic Surgery and Value-Based Health Care Delivery, Dell Medical School, University of Texas at Austin, Austin, TX, USA 2Professor of Orthopedic Surgery and Chair, Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, TX, USA K. J. Bozic, Dell Medical School at the University of Texas at Austin, 1701 Trinity Street, Austin, TX 78712, USA, Email: [email protected] A note from the Editor-in-Chief: We are pleased to present to readers of Clinical Orthopaedics and Related Research® the latest Value-based Healthcare column (formerly Orthopaedic Healthcare Worldwide). Value-based Healthcare explores strategies to enhance the value of musculoskeletal care by improving health outcomes and reducing the overall cost of care delivery. We welcome reader feedback on all of our columns and articles; please send your comments to[email protected]. One author (KJB) certifies receipt of personal payments or benefits as a consultant, during the study period, an amount of USD 10,000 to USD 100,000 from The Centers for Medicare & Medicaid Services. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

The Prognostic Value of CAC Zero Among Individuals Presenting With Chest Pain: A Meta-Analysis

BackgroundThere is little consensus on whether absence of coronary artery calcium (CAC) can identify patients with chest pain (CP) who can safely avoid additional downstream testing. ObjectivesThe purpose of this study was to conduct a systematic review and meta-analysis investigating the utility of CAC assessment for ruling out obstructive coronary artery disease (CAD) among patients with stable and acute CP, at low-to-intermediate risk of obstructive CAD undergoing coronary computed tomography angiography (CTA). MethodsThe authors searched online databases for studies published between 2005 and 2021 examining the relationship between CAC and obstructive CAD (≥50% coronary luminal narrowing) on coronary CTA among patients with stable and acute CP. ResultsIn this review, the authors included 19 papers comprising 79,903 patients with stable CP and 13 papers including 12,376 patients with acute CP undergoing simultaneous CAC and coronary CTA assessment. Overall, 45% (95% CI: 40%-50%) of patients with stable CP and 58% (95% CI: 50%-66%) of patients with acute CP had CAC = 0. The negative predictive values for CAC = 0 ruling out obstructive CAD were 97% (95% CI: 96%-98%) and 98% (95% CI: 96%-99%) among patients with stable and acute CP, respectively. Additionally, the prevalence of nonobstructive CAD among those with CAC = 0 was 13% (95% CI: 10%-16%) among those with stable CP and 9% (95% CI: 5%-13%) among those with acute CP. A CAC score of zero predicted a low incidence of major adverse cardiac events among patients with stable CP (0.5% annual event rate) and acute CP (0.8% overall event rate). ConclusionsAmong over 92,000 patients with stable or acute CP, the absence of CAC was associated with a very low prevalence of obstructive CAD, a low prevalence of nonobstructive CAD, and a low annualized risk of major adverse cardiac events. These findings support the role of CAC = 0 in a value-based health care delivery model as a “gatekeeper” for more advanced imaging among patients presenting with CP.

Cost-volume analysis of deep inferior epigastric artery perforator flaps for breast reconstruction in the United States

BackgroundDeep inferior epigastric artery perforator flaps are increasingly utilized over other autologous methods of breast reconstruction. We evaluated the relationship between annual hospital volume and costs after breast reconstruction with the deep inferior epigastric artery perforator flap. MethodsAll female patients undergoing elective implant or autologous tissue breast reconstruction were identified using the 2016–2019 Nationwide Readmission Database. Annual hospital volume of deep inferior epigastric artery perforator reconstructions was tabulated and modeled using restricted cubic splines. Institutions were categorized into high- and low-volume based on the inflection point of the spline between annual caseload and costs. The association between high volume status and costs, complications, length of stay, and 30-day nonelective readmission was assessed using multivariable regression. ResultsOf an estimated 94,524 patients meeting inclusion criteria, 33,046 (34.6%) underwent deep inferior epigastric artery perforator flap reconstruction. Deep inferior epigastric artery perforator flap utilization increased from 31% in 2016 to 40% in 2019 (P < .001) among inpatient breast reconstructions. High-volume hospitals more frequently performed bilateral reconstructions (43.3 vs 37.7%, P = .021) but had similar rates of concurrent mastectomy (28.7 vs 30.6%, P = .46), relative to low-volume hospitals. The median cost of deep inferior epigastric artery perforator reconstruction was lower ($29,900 [interquartile range: 22,400–37,400] vs $31,600 [interquartile range: 22,500–44,900], P = .036) at high-volume hospitals compared to low-volume. On adjusted analysis, high-volume status was associated a $3,800 (95% confidence interval: -6,200 to -1,400) decrement in hospitalization costs, and reduced odds of perioperative complications (adjusted odd ratio: 0.68 95% confidence interval: 0.54–0.86). High-volume status was not associated with length of stay or likelihood of unplanned readmission. ConclusionThe present study demonstrated an inverse cost–volume relationship in deep inferior epigastric artery perforator flap breast reconstruction. In line with goals of value-based health care delivery, our findings may inform referral patterns to suitable centers for deep inferior epigastric artery perforator breast reconstruction.

PD17-02 COST IMPLICATIONS OF INFECTIOUS COMPLICATIONS FOLLOWING PROSTATE BIOPSIES IN THE UNITED STATES

You have accessJournal of UrologyCME1 May 2022PD17-02 COST IMPLICATIONS OF INFECTIOUS COMPLICATIONS FOLLOWING PROSTATE BIOPSIES IN THE UNITED STATES Sharon White, Eric Ballon-Landa, Michael Bronsert, Boris Gershman, Peter Clark, Granville Lloyd, Jeffrey Morrison, Rodrigo Rodrigues-Pessoa, Marc Smaldone, Anessa Sax-Bolder, and Simon Kim Sharon WhiteSharon White More articles by this author , Eric Ballon-LandaEric Ballon-Landa More articles by this author , Michael BronsertMichael Bronsert More articles by this author , Boris GershmanBoris Gershman More articles by this author , Peter ClarkPeter Clark More articles by this author , Granville LloydGranville Lloyd More articles by this author , Jeffrey MorrisonJeffrey Morrison More articles by this author , Rodrigo Rodrigues-PessoaRodrigo Rodrigues-Pessoa More articles by this author , Marc SmaldoneMarc Smaldone More articles by this author , Anessa Sax-BolderAnessa Sax-Bolder More articles by this author , and Simon KimSimon Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002555.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Infectious complications following transrectal ultrasound prostate biopsies (TRUS-PB) represent a growing burden in the U.S. Understanding the health care costs attributable to these adverse outcomes following this common urologic procedure is essential but remains largely unknown. Herein, we describe the economic burden attributable to post TRUS-PB infectious complications from a population-based cohort of privately-insured patients. METHODS: From 2010 to 2015, we identified all patients who underwent an incident TRUS PB from MarketScan. Health care costs and patient out-of-pocket costs due to infectious complications requiring hospital admission and emergency room (ER) visits within 30 days of the TRUS-PB represented the primary outcome. Multivariable analyses were used to identify patient characteristics associated with higher health care and out-of-pocket costs. RESULTS: Overall, 193,490 patients underwent TRUS-PB and the mean age was 57.6 years (SD: 5.0). The rates of infectious complications requiring ER visits and hospital admissions were 0.4 and 1.2 per 100 prostate biopsies. Compared to patients who did not experience any infectious complications, patient admitted to hospital within 30 days had higher health care costs ($14,057 vs. $625; p < 0.001) and out-of-pocket costs ($80 vs. $9; p<.0001). Similarly, patients who required ER visits also had higher total health care costs compared to those who did not experience infectious complications ($141 vs. $4; p<.0001). Higher aggregate health care costs ($14,198 vs. $629; p<.0001) and out-of-pockets costs ($89 vs. $18; p<.0001) were observed for patients who sustained infectious complications. The total health care cost for infections was $38,234,689 On multivariable analyses, patients who had Elixhauser index defined comorbidities had total health care costs (p<0.001). CONCLUSIONS: Infectious complications following TRUS-PB are associated with significant economic burden to the health care system and patients. Efforts to reduce post TRUS-PB infectious complications can significantly improve value-based health care delivery. Source of Funding: This study was supported by the Schramm Foundation © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e336 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sharon White More articles by this author Eric Ballon-Landa More articles by this author Michael Bronsert More articles by this author Boris Gershman More articles by this author Peter Clark More articles by this author Granville Lloyd More articles by this author Jeffrey Morrison More articles by this author Rodrigo Rodrigues-Pessoa More articles by this author Marc Smaldone More articles by this author Anessa Sax-Bolder More articles by this author Simon Kim More articles by this author Expand All Advertisement PDF DownloadLoading ...

Cost comparison and complication profiles of superior capsular reconstruction, lower trapezius transfer, and reverse shoulder arthroplasty for irreparable rotator cuff tears.

Irreparable rotator cuff tears (IRCTs) pose treatment challenges both clinically and financially. As cost-effectiveness initiatives are prioritized, value-based health care delivery models are becoming increasingly common. The purpose of this study was to perform a comprehensive analysis of the cost, complications, and readmission rates of 3 common surgical treatment options for IRCTs: superior capsular reconstruction (SCR), arthroscopically assisted lower trapezius tendon transfer (LTTT), and reverse shoulder arthroplasty (RSA). Between 2018 and 2020, 155 patients who underwent shoulder surgery at a single institution for IRCT with minimal to no arthritis were identified. Procedures performed included 20 SCRs, 47 LTTTs, and 88 RSAs. A cost analysis was designed to include a period of 60 days preoperatively, the index surgical hospitalization, and 90 days postoperatively, including costs of any readmission or reoperation. Mean standardized costs were as follows: preoperative evaluation SCR $507, LTTT $507, and RSA $730; index surgical hospitalization SCR $19,675, LTTT $15,722, and RSA $16,077; and postoperative care SCR $655, LTTT $686, and RSA $404. Significant differences were observed in the index surgical costs (P < .001), with SCR incurring an additional average cost of $3953 and $3598 compared with LTTT and RSA, respectively. The 90-day complication, reoperation, and readmission rates were 0%, 0%, and 0% in the SCR group; 2.1%, 0%, and 0% in the LTTT group; and 3.4%, 0%, and 1.1% in the RSA group, respectively. With the numbers available, differences among the 3 surgical procedures with respect to complication (P = .223), reoperation (P = .999), and readmission rates (P = .568) did not reach statistical significance. The mean standardized costs for the treatment of 3 common IRCT procedures inclusive of 60-day workup and 90-day postoperative recovery were $16,915, $17,210, and $20,837 for LTTT, RSA (average added cost $295), and SCR (average added cost $3922), respectively. This information may provide surgeons and institutions with cost-related information that will become increasingly relevant with the expansion of value-based surgical reimbursements.

Development of a value-based healthcare delivery model for sarcoma patients.

The urgent need to restructure healthcare delivery to address rising costs has been recognised. Value-based health care aims to deliver high and rising value for the patient by addressing unmet needs and controlling costs. Sarcoma is a rare disease and its care is therefore usually not organised as an institutional discipline. It comprises a set of various diagnostic entities and is highly transdisciplinary. A bottom-up approach to establishing sarcoma integrated practice units (IPUs) faces many challenges, but ultimately allows the scaling up of quality and outcomes of patient care, specific knowledge, experience and education. The key for value-based health care - besides defining the shared value of quality - is an integrated information technology platform that allows transparency by sharing values, brings all stakeholders together in real-time, and offers the opportunity to assess quality of care and outcomes, thereby ultimately saving costs. Sarcoma as a rare disease may serve as a model of how to establish IPUs through a supraregional network by increased connectivity, to advance patient care, to improve science and education, and to control costs in the future, thereby restructuring healthcare delivery. This article describes how the value-based health care delivery principles are being adopted and fine-tuned to the care of sarcoma patients, and already partially integrated in seven major referral hospitals in Switzerland.

Digital medical history implementation to triage orthopaedic patients during COVID-19: Findings from a rapid cycle, semi-randomised A/B testing quality improvement project.

IntroductionThe COVID‐19 pandemic severely impacted musculoskeletal care. To better triage the notable backlog of patients, we assessed whether a digital medical history (DMH), a summary of health information and concerns completed by the patient prior to a clinic visit, could be routinely collected and utilised.MethodsWe analysed 640 patients using a rapid cycle, semi‐randomised A/B testing approach. Four rapid cycles of different randomised interventions were conducted across five unique patient groups. Descriptive statistics were used to report DMH completion rates by cycle/patient group and intervention. Multivariable logistic regression was used to determine whether age or anatomic injury location was associated DMH completion.Ethical ApprovalN/A (Quality Improvement Project)ResultsAcross all patients, the DMH completion rate was 48% (307/640). Phone calls were time consuming and resource intensive without an increased completion rate. The highest rate of DMH completion was among patients who were referred and called the clinic themselves (78% of patients [63 out of 81 patients]). Across all patients, increasing age (odds ratio [OR]: 0.985 (95% CI: 0.976–0.995), p = 0.002), patients with back concerns (OR: 0.395 (95% CI: 0.234–0.666), p = 0.001), and patients with non‐specific/other musculoskeletal concerns (OR: 0.331 (95% CI: 0.176–0.623), p = 0.001) were associated with decreased odds of DMH completion.Discussion and ConclusionDMHs can be valuable in helping triage orthopaedic patients in resource‐strapped settings, times of crisis, or as we transition towards value‐based health care delivery. However, further work is needed to continue to increase the completion rate about 50%.

Towards value-based healthcare: Establishing baseline pharmacy care costs for diabetes management.

The prevalence of diabetes has increased by three folds over the last 20 years, and the global cost of diabetes mellitus surpassed one trillion US Dollars (USD) or 1.8% of the global GDP in 2015. Generally, prescription medication to treat complications of diabetes makes up nearly 30% of diabetes medical expenditures. To facilitate value-based decision-making at national and organizational levels, we analyzed the cost drivers of pharmacy services in a diabetes care institute by developing a flexible costing model that accounts for pharmaceuticals and labour costs of pharmacy processes. We calculated the direct pharmaceutical costs and the indirect labour costs at the activity level from electronic health records and observational data. On average, the cost of pharmacy services over 1 year was equivalent to 1246 USD per diabetes patient. Approximately 98% of the pharmacy costs were pharmaceutical costs, while 2% were attributable to labour. The flexible costing model and cost estimates are essential for value-based comparisons of interventions and care redesign. The outlined costing framework and findings carry implications nationally and organizationally to accelerate the path towards value-based healthcare delivery and provider reimbursement schemes through agile cost estimation, efficiency improvements, and higher value of care.

Patient-reported outcome and experience measures for peripheral venous catheters: a scoping review protocol.

The purpose of this scoping review is to conduct a systematic search and establish the current state of evidence for tools and instruments used to measure self-reported outcomes and experiences, including satisfaction scores, specifically for peripheral venous access devices (PVADs). A systematic search of the literature will be conducted using medical databases including: MEDLINE (Ovid); CINAHL (EbscoHost); PubMed (NCBI); and Scopus (Elsevier); Google (Scholar); and the Cochrane Central Register of Controlled Trials. Experimental, and observational studies, published in English, after 1990 will be eligible for inclusion if they: consist of (i) a survey, instrument or tool that is designed to (ii) collect outcome, experience and/or satisfaction data, relating to PVAD insertion, care, maintenance and/or removal, among (iii) adult and paediatric participants. PVAD-specific patient-reported outcome and experience measures are necessary for researchers, clinicians and policy decision makers to explore more thoroughly the quality of PVAD care provided, and further inform health economic analyses in the context of quality improvement interventions for vascular access devices. This scoping review will establish the existence-or paucity-of instruments to measure these selfreported outcomes and experiences of PVADs, in order to guide value-based healthcare delivery into the future.