McCreary Dylan L, Dugarte Anthony J, Vang Sandy, Plowman Brad, Williams Benjamin R, Parikh Harsh R, Cunningham Brian P
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN.
Department of Financial Planning and Decision Support, Regions Hospital, Saint Paul, MN.
J Orthop Trauma. 2019 Nov;33 Suppl 7:S49-S52. doi: 10.1097/BOT.0000000000001624.
An increasing emphasis has been placed on developing value-based care delivery systems in orthopaedics to combat rising health care costs. The goal of these systems is to both measure and improve the provisional value of care. Patient-level value analysis creates a mechanism to quantify and optimize value within a procedure, in contrast to traditional methods, which only measures value. The purpose of this study was to develop a patient-level value analysis model and determine the efficacy of this model to improve value in orthopaedic care.
Patients treated operatively for isolated closed ankle fractures at a single level 1 trauma center were prospectively identified. Short musculoskeletal function assessment was collected at the time of the initial clinical presentation and 6 months postoperatively. The cost of care was determined using time-driven activity-based costing, which included personnel, supplies, length of stay, implants, pharmacy, and radiology. Value was defined as each patient's change in the outcome score divided by their cost as determined by time-driven activity-based costing. A multiple linear regression was performed to determine which aspects of care significantly predicted value.
Forty-nine patients met inclusion/exclusion criteria. The multiple linear regression indicated treatment by physician D (β = -0.135, P = 0.04) and inpatient stay (β = -0.468, P < 0.01) were predictors of lesser value and represent areas for potential care pathway and value improvement.
Patient-level value analysis represents a paradigm shift in the quantification of value. We recommend surgeons, practices, and health care systems begin implementing a system to quantify and optimize the value of care provided.
Level III. See Instructions for Authors for a complete description of levels of evidence.
为应对不断上涨的医疗保健成本，骨科领域越来越重视发展基于价值的医疗服务体系。这些体系的目标是衡量并提高医疗服务的临时价值。与仅衡量价值的传统方法不同，患者层面的价值分析创建了一种机制，用于量化和优化手术中的价值。本研究的目的是开发一种患者层面的价值分析模型，并确定该模型在提高骨科医疗价值方面的有效性。
前瞻性地确定在一家一级创伤中心接受手术治疗的单纯闭合性单踝骨折患者。在初次临床表现时和术后6个月收集简短的肌肉骨骼功能评估。使用时间驱动作业成本法确定护理成本，其中包括人员、用品、住院时间、植入物、药房和放射学。价值定义为每个患者的结局评分变化除以由时间驱动作业成本法确定的成本。进行多元线性回归以确定护理的哪些方面显著预测价值。
四十九名患者符合纳入/排除标准。多元线性回归表明，医生D的治疗（β = -0.135，P = 0.04）和住院时间（β = -0.468，P < 0.01）是价值较低的预测因素，代表了潜在护理路径和价值改善的领域。
患者层面的价值分析代表了价值量化方面的范式转变。我们建议外科医生、医疗机构和医疗保健系统开始实施一种系统，以量化和优化所提供护理的价值。
三级。有关证据水平的完整描述，请参阅作者指南。
