Lee Matthew J, Mohamed Khalid M S, Kelly John C, Galbraith John G, Street John, Lenehan Brian J
Department of Orthopaedic Surgery, Mid Western Orthopaedic Regional Hospital, University Hospital Limerick, Limerick, Ireland.
Department of Orthopaedic Surgery, Vancouver General Hospital, University of British Columbia, British Columbia, Canada.
J Arthroplasty. 2017 Sep;32(9):2648-2654. doi: 10.1016/j.arth.2017.03.049. Epub 2017 Apr 11.
In Ireland, funding of joint arthroplasty procedures has moved to a pay-by-results national tariff system. Typically, adverse clinical events are recorded via retrospective chart-abstraction methods by administrative staff. Missed or undocumented events not only affect the quality of patient care but also may unrealistically skew budgetary decisions that impact fiscal viability of the service. Accurate recording confers clinical benefits and financial transparency. The aim of this study was to compare a prospectively implemented adverse events form with the current national retrospective chart-abstraction method in terms of pay-by-results financial implications.
An adverse events form adapted from a similar validated model was used to prospectively record complications in 51 patients undergoing total hip or knee arthroplasties. Results were compared with the same cohort using an existing data abstraction method. Both data sets were coded in accordance with current standards for case funding.
Overall, 114 events were recorded during the study through prospective charting of adverse events, compared with 15 events documented by customary method (a significant discrepancy). Wound drainage (15.8%) was the most common complication, followed by anemia (7.9%), lower respiratory tract infections (7.9%), and cardiac events (7%). A total of €61,956 ($67,778) in missed funding was calculated as a result.
This pilot study demonstrates the ability to improve capture of adverse events through use of a well-designed assessment form. Proper perioperative data handling is a critical aspect of financial subsidies, enabling optimal allocation of funds.
在爱尔兰，关节置换手术的资金已转向按结果付费的国家收费系统。通常，不良临床事件由行政人员通过回顾性病历摘要方法进行记录。漏记或未记录的事件不仅会影响患者护理质量，还可能不切实际地扭曲预算决策，进而影响服务的财政可行性。准确记录可带来临床益处和财务透明度。本研究的目的是就按结果付费的财务影响，比较前瞻性实施的不良事件表格与当前国家回顾性病历摘要方法。
采用一种改编自类似经过验证模型的不良事件表格，前瞻性记录51例接受全髋关节或膝关节置换术患者的并发症。使用现有的数据摘要方法将结果与同一队列进行比较。两个数据集均按照病例资金的现行标准进行编码。
总体而言，在研究期间通过前瞻性记录不良事件共记录了114起事件，而传统方法记录了15起事件（差异显著）。伤口引流（15.8%）是最常见的并发症，其次是贫血（7.9%）、下呼吸道感染（7.9%）和心脏事件（7%）。结果计算出共遗漏资金61,956欧元（67,778美元）。
这项试点研究表明，通过使用精心设计的评估表格能够改善不良事件的记录。围手术期数据的妥善处理是财政补贴的一个关键方面，有助于实现资金的优化分配。
