1
|
Janda AM, Vaughn MT, Colquhoun D, Mentz G, Buehler MS RN CPPS K, Nathan H, Regenbogen SE, Syrjamaki J, Kheterpal S, Shah N. Does Anesthesia Quality Improvement Participation Lead to Incremental Savings in a Surgical Quality Collaborative Population? A Retrospective Observational Study. Anesth Analg 2023; 137:1093-1103. [PMID: 37678254 PMCID: PMC10592579 DOI: 10.1213/ane.0000000000006565] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND The Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) Collaborative Quality Initiative (CQI) was launched as a partnership among hospitals to measure quality, review evidence-based practices, and improve anesthesia-related outcomes. Cost savings and improved patient outcomes have been associated with surgical CQI participation, but the impact of an anesthesia CQI on health care cost has not been thoroughly assessed. In this study, we evaluated whether participation in an anesthesia CQI led to health care savings. We hypothesized that ASPIRE participation is associated with reduced total episode payments for payers and major, high-volume procedures included in the Michigan Value Collaborative (MVC) registry. METHODS In this retrospective observational study, we compared MVC episode payment data from Group 1 ASPIRE hospitals, the first cluster of 8 Michigan hospitals to join ASPIRE in January 2015, to non-ASPIRE matched control hospitals. MVC computes price-standardized, risk-adjusted payments for patients insured by Blue Cross Blue Shield of Michigan Preferred Provider Organization, Blue Care Network Health Maintenance Organization, and Medicare Fee-for-Service plans. Episodes from 2014 comprised the pre-ASPIRE time period, and episodes from June 2016 to July 2017 constituted the post-ASPIRE time period. We performed a difference-in-differences analysis to evaluate whether ASPIRE implementation was associated with greater reduction in total episode payments compared to the change in the control hospitals during the same time periods. RESULTS We found a statistically significant reduction in total episode (-$719; 95% CI [-$1340 to -$97]; P = .023) payments at the 8 ASPIRE hospitals (N = 17,852 cases) compared to the change observed in 8 matched non-ASPIRE hospitals (N = 12,987 cases) for major, high-volume surgeries, including colectomy, colorectal cancer resection, gastrectomy, esophagectomy, pancreatectomy, hysterectomy, joint replacement (knee and hip), and hip fracture repair. In secondary analyses, 30-day postdischarge (-$354; 95% CI [-$582 to -$126]; P = .002) payments were also significantly reduced in ASPIRE hospitals compared to non-ASPIRE controls. Subgroup analyses revealed a significant reduction in total episode payments for joint replacements (-$860; 95% CI [-$1222 to -$499]; P < .001) at ASPIRE-participating hospitals. Sensitivity analyses including patient-level covariates also showed consistent results. CONCLUSIONS Participation in an anesthesiology CQI, ASPIRE, is associated with lower total episode payments for selected major, high-volume procedures. This analysis supports that participation in an anesthesia CQI can lead to reduced health care payments.
Collapse
Affiliation(s)
- Allison M. Janda
- Department of Anesthesiology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Michelle T. Vaughn
- Department of Anesthesiology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Douglas Colquhoun
- Department of Anesthesiology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Graciela Mentz
- Department of Anesthesiology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Kathryn Buehler MS RN CPPS
- Department of Anesthesiology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Hari Nathan
- Department of Surgery, Michigan Medicine, Ann Arbor, MI 48109, USA
| | | | - John Syrjamaki
- Michigan Value Collaborative (MVC), Department of Surgery, Michigan Medicine, Ann Arbor, MI 48109, USA
| | - Sachin Kheterpal
- Department of Anesthesiology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Nirav Shah
- Department of Anesthesiology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| |
Collapse
|
2
|
Carroll G, Safon C, Buccini G, Vilar-Compte M, Teruel G, Pérez-Escamilla R. A systematic review of costing studies for implementing and scaling-up breastfeeding interventions: what do we know and what are the gaps? Health Policy Plan 2020; 35:461-501. [PMID: 32073628 DOI: 10.1093/heapol/czaa005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2020] [Indexed: 12/17/2022] Open
Abstract
Despite the well-established evidence that breastfeeding improves maternal and child health outcomes, global rates of exclusive breastfeeding remain low. Cost estimates can inform stakeholders about the financial resources needed to scale up interventions to ultimately improve breastfeeding outcomes in low-, middle- and high-income countries. To inform the development of comprehensive costing frameworks, this systematic review aimed to (1) identify costing studies for implementing or scaling-up breastfeeding interventions, (2) assess the quality of identified costing studies and (3) examine the availability of cost data to identify gaps that need to be addressed through future research. Peer-reviewed and grey literature were systematically searched using a combination of index terms and relevant text words related to cost and the following breastfeeding interventions: breastfeeding counselling, maternity leave, the World Health Organization International Code of Marketing of Breastmilk Substitutes, the Baby-Friendly Hospital Initiative, media promotion, workplace support and pro-breastfeeding social policies. Data were extracted after having established inter-rater reliability among the first two authors. The quality of studies was assessed using an eight-item checklist for key costing study attributes. Forty-five studies met the inclusion criteria, with the majority including costs for breastfeeding counselling and paid maternity leave. Most cost analyses included key costing study attributes; however, major weaknesses among the studies were the lack of clarity on costing perspectives and not accounting for the uncertainty of reported cost estimates. Costing methodologies varied substantially, standardized costing frameworks are needed for reliably estimating the costs of implementing and scaling-up breastfeeding interventions at local-, national- or global-levels.
Collapse
Affiliation(s)
- Grace Carroll
- Department of Social and Behavioral Sciences, Yale School of Public Health, 135 College St. Suite 200, New Haven, CT 06510, USA
| | - Cara Safon
- Department of Social and Behavioral Sciences, Yale School of Public Health, 135 College St. Suite 200, New Haven, CT 06510, USA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Talbot Building, 715 Albany Street, Boston, MA 02118, USA
| | - Gabriela Buccini
- Department of Social and Behavioral Sciences, Yale School of Public Health, 135 College St. Suite 200, New Haven, CT 06510, USA
| | - Mireya Vilar-Compte
- EQUIDE Research Institute for Equitable Development, Universidad Iberoamericana, Prolongacion Paseo de la Reforma 880, Santa Fe, Zedec Sta Fé, Álvaro Obregón, 01219 Ciudad de México, CDMX, Mexico
| | - Graciela Teruel
- EQUIDE Research Institute for Equitable Development, Universidad Iberoamericana, Prolongacion Paseo de la Reforma 880, Santa Fe, Zedec Sta Fé, Álvaro Obregón, 01219 Ciudad de México, CDMX, Mexico
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, 135 College St. Suite 200, New Haven, CT 06510, USA
| |
Collapse
|
3
|
Fifty Years of WIC: Celebration and Caution. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 26:3-4. [DOI: 10.1097/phh.0000000000001110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
4
|
Dawn of a New Era: Performance Improvement in Public Health. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 25:515-517. [PMID: 31348168 DOI: 10.1097/phh.0000000000001057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
5
|
Santacruz-Salas E, Aranda-Reneo I, Hidalgo-Vega Á, Blanco-Rodriguez JM, Segura-Fragoso A. The Economic Influence of Breastfeeding on the Health Cost of Newborns. J Hum Lact 2019; 35:340-348. [PMID: 30508488 DOI: 10.1177/0890334418812026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Breastfeeding provides health benefits for women and newborns. However, few studies have explored how these health benefits translate into economic savings. RESEARCH AIM This study aimed to estimate the healthcare costs savings generated by exclusive breastfeeding for healthy newborns. METHODS We designed a longitudinal two-group observational study that included healthy women and newborns ( N = 236) in Toledo, Spain. Over the first 6-months of the infants' lives, we reviewed their clinical histories to determine their consumption of healthcare resources and the type of nutrition provided. The sample was categorized into two groups: exclusive breastfeeding ( n = 46) and non-exclusive breastfeeding for 6 months ( n = 190). Two-part regression models were applied to determine whether there were differences in healthcare costs between the groups. RESULTS The average age of the women was 32 ( SD: 5.3). The average birth weight of the newborns was 3.3 kg. ( SD: 0.38). At 6 months, 19.5% ( n = 46) of the women breastfed exclusively, 28.4% ( n = 67) combined breastfeeding with formula, and 45.8% ( n = 108) used formula only. Healthcare costs during follow-up reached €785.58 (44% for specialized care, 42% for primary care, 9.8% for medical emergencies, 3% for medications and approximately 1% for medical tests). The statistical analysis estimated a lower healthcare cost of between €454.40 and €503.50 for exclusively breastfed newborns. CONCLUSION Breastfeeding generated savings in healthcare costs; therefore, it could be a cost-efficient option compared with alternatives. Researchers who evaluate the efficiency of strategies that promote breastfeeding can contribute to the sustainability of health services.
Collapse
Affiliation(s)
- Esmeralda Santacruz-Salas
- 1 Faculty of Occupational Therapy, Speech Therapy and Nursing, University of Castilla-La Mancha, Talavera de la Reina. Toledo, Spain
| | - Isaac Aranda-Reneo
- 2 Faculty of Social Sciences, University of Castilla-La Mancha, Talavera de la Reina. Toledo, Spain
| | - Álvaro Hidalgo-Vega
- 3 Faculty of Law and Social Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - José M Blanco-Rodriguez
- 4 Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
| | - Antonio Segura-Fragoso
- 1 Faculty of Occupational Therapy, Speech Therapy and Nursing, University of Castilla-La Mancha, Talavera de la Reina. Toledo, Spain
| |
Collapse
|
6
|
Shen X, Diao M, Lu M, Feng R, Zhang P, Jiang T, Wang D. Pathways and cost-effectiveness of routine lung cancer inpatient care in rural Anhui, China: a retrospective cohort study protocol. BMJ Open 2018; 8:e018519. [PMID: 29463588 PMCID: PMC5879485 DOI: 10.1136/bmjopen-2017-018519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Routine inpatient care (RIC) for patients with cancer forms various pathways of clinical procedures. Although most individual procedures comprising the pathways have been tested via clinical trials, little is known about the collective cost and effectiveness of the pathways as a whole. This study aims at exploring RIC pathways for patients with lung cancer from rural Anhui, China, and their determinants and economic impacts. METHODS AND ANALYSIS The study adopts a retrospective cohort design and proceeds in five steps. Step 1 defines the four main categories of study variables, including clinical procedures, direct cost and effectiveness of procedures, and factors affecting use of these procedures and their cost and effectiveness. Step 2 selects a cohort of 5000 patients with lung cancer diagnosed between 1 July 2015 and 30 June 2016 from rural Anhui by clustered random sampling. Step 3 retrieves the records of all the inpatient care episodes due to lung cancer and extracts data about RIC procedures, proximate variables (eg, Karnofsky Performance Status, Lung Function Score) of patient outcomes and related factors (eg, stage of cancer, age, gender), by two independent clinician researchers using a web-based form. Step 4 estimates the direct cost of each of the RIC procedures using micro-costing and collects data about ultimate patient outcomes (survival and progression-free survival) through a follow-up survey of patients and/or their close relatives. Step 5 analyses the data collected and explores pathways of RIC procedures and their relations with patient outcomes, costs, cost:effect ratios, and a whole range of clinical and sociodemographic factors using multivariate regression and path models. ETHICS AND DISSEMINATION The study protocol has been approved by an authorised ethics committee of Anhui Medical University (reference number: 20170312). Findings from the study will be disseminated through conventional academic routes such as peer-reviewed publications and presentations at regional, national and international conferences. TRIAL REGISTRATION NUMBER ISRCTN25595562.
Collapse
Affiliation(s)
- XingRong Shen
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - MengJie Diao
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - ManMan Lu
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - Rui Feng
- Department of Literature Review and Analysis, Library of Anhui Medical University, Hefei, Anhui, China
| | - PanPan Zhang
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - Tao Jiang
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - DeBin Wang
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| |
Collapse
|