RT Journal Article
SR Electronic
T1 Bending the cost curve: time series analysis of a value transformation programme at an academic medical centre
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 449
OP 458
DO 10.1136/bmjqs-2018-009068
VO 28
IS 6
A1 Steven C Chatfield
A1 Frank M Volpicelli
A1 Nicole M Adler
A1 Kunhee Lucy Kim
A1 Simon A Jones
A1 Fritz Francois
A1 Paresh C Shah
A1 Robert A Press
A1 Leora I Horwitz
YR 2019
UL http://qualitysafety.bmj.com/content/28/6/449.abstract
AB Background Reducing costs while increasing or maintaining quality is crucial to delivering high value care.Objective To assess the impact of a hospital value-based management programme on cost and quality.Design Time series analysis of non-psychiatric, non-rehabilitation, non-newborn patients discharged between 1 September 2011 and 31 December 2017 from a US urban, academic medical centre.Intervention NYU Langone Health instituted an institution-wide programme in April 2014 to increase value of healthcare, defined as health outcomes achieved per dollar spent. Key features included joint clinical and operational leadership; granular and transparent cost accounting; dedicated project support staff; information technology support; and a departmental shared savings programme.Measurements Change in variable direct costs; secondary outcomes included changes in length of stay, readmission and in-hospital mortality.Results The programme chartered 74 projects targeting opportunities in supply chain management (eg, surgical trays), operational efficiency (eg, discharge optimisation), care of outlier patients (eg, those at end of life) and resource utilisation (eg, blood management). The study cohort included 160 434 hospitalisations. Adjusted variable costs decreased 7.7% over the study period. Admissions with medical diagnosis related groups (DRG) declined an average 0.20% per month relative to baseline. Admissions with surgical DRGs had an early increase in costs of 2.7% followed by 0.37% decrease in costs per month. Mean expense per hospitalisation improved from 13% above median for teaching hospitals to 2% above median. Length of stay decreased by 0.25% per month relative to prior trends (95% CI −0.34 to 0.17): approximately half a day by the end of the study period. There were no significant changes in 30-day same-hospital readmission or in-hospital mortality. Estimated institutional savings after intervention costs were approximately $53.9 million.Limitations Observational analysis.Conclusion A systematic programme to increase healthcare value by lowering the cost of care without compromising quality is achievable and sustainable over several years.