NYU Langone Health, New York, NY, USA.
Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU School of Medicine, New York, NY, USA.
BMJ Qual Saf. 2019 Jun;28(6):449-458. doi: 10.1136/bmjqs-2018-009068. Epub 2019 Mar 15.
Reducing costs while increasing or maintaining quality is crucial to delivering high value care.
To assess the impact of a hospital value-based management programme on cost and quality.
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.
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.
Change in variable direct costs; secondary outcomes included changes in length of stay, readmission and in-hospital mortality.
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.
Observational analysis.
A systematic programme to increase healthcare value by lowering the cost of care without compromising quality is achievable and sustainable over several years.
在提供高价值医疗服务的过程中，降低成本并同时提高或维持服务质量至关重要。
评估医院基于价值的管理方案对成本和质量的影响。
对 2011 年 9 月 1 日至 2017 年 12 月 31 日期间从美国城市学术医疗中心出院的非精神科、非康复科、非新生儿患者进行非精神病、非康复、非新生儿患者的时间序列分析。
纽约大学朗格尼健康中心于 2014 年 4 月实施了一项全院范围的计划，旨在提高医疗保健的价值，即每花费一美元所获得的健康结果。主要特点包括联合临床和运营领导；详细和透明的成本核算；专门的项目支持人员；信息技术支持；以及部门共享节约计划。
可变直接成本的变化；次要结果包括住院时间、再入院率和院内死亡率的变化。
该计划制定了 74 个项目，针对供应链管理（例如，手术托盘）、运营效率（例如，出院优化）、特殊患者护理（例如，临终患者）和资源利用（例如，血液管理）方面的机会。研究队列包括 160434 例住院患者。在研究期间，调整后的可变成本下降了 7.7%。与基线相比，具有医疗诊断相关组（DRG）的入院人数平均每月减少 0.20%。具有手术 DRG 的入院人数在成本早期增加了 2.7%，随后每月减少 0.37%。每个住院患者的平均费用从教学医院中位数的 13%提高到中位数的 2%。与之前的趋势相比，住院时间每月减少 0.25%（95%CI-0.34 至 0.17）：在研究结束时大约减少了半天。30 天内同一医院再入院或院内死亡率没有显著变化。干预后成本估计机构节省约 5390 万美元。
观察性分析。
通过降低医疗成本而不影响质量来提高医疗保健价值的系统方案是可行的，并可持续数年。
