大型学术医院中基于价值的术前评估

Value-based preoperative assessment in a large academic hospital.

作者信息

Cecconi Maurizio, Goretti Giulia, Pradella Andrea, Meroni Patrizia, Pisarra Martina, Torzilli Guido, Montorsi Marco, Spinelli Antonino, Zerbi Alessandro, Castoro Carlo, Casale Paolo, Civilini Efrem, Quagliuolo Vittorio, Klinger Marco, Spriano Giuseppe, Vitobello Domenico, Maradei Leonardo, Reimers Bernhard, Piccioni Federico, Martucci Maria Rosaria, Stomeo Niccolò, Vanni Elena, Babbini Marco, Monzani Roberta, Capogreco Maria Rosaria, Lagioia Michele, Greco Massimiliano

机构信息

Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.

Department of Anaesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.

出版信息

J Anesth Analg Crit Care. 2024 Jul 8;4(1):42. doi: 10.1186/s44158-024-00161-7.

DOI:10.1186/s44158-024-00161-7

PMID:38978057

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11232329/

Abstract

BACKGROUND

Value-based healthcare (VBHC) is an approach that focuses on delivering the highest possible value for patients while driving cost efficiency in health services. It emphasizes improving patient outcomes and experiences while optimizing the use of resources, shifting the healthcare system's focus from the volume of services to the value delivered. Our study assessed the effectiveness of implementing a VBHC-principled, tailored preoperative evaluation in enhancing patient care and outcomes, as well as reducing healthcare costs.

METHODS

We employed a quality improvement, before-and-after approach to assessing the effects of implementing VBHC strategies on the restructuring of the preoperative evaluation clinics at Humanitas Research Hospital. The intervention introduced a VBHC-tailored risk matrix during the postintervention phase (year 2021), and the results were compared with those of the preintervention phase (2019). The primary study outcome was the difference in the number of preoperative tests and visits at baseline and after the VBHC approach. Secondary outcomes were patient outcomes and costs.

RESULTS

A total of 9722 patients were included: 5242 during 2019 (baseline) and 4,480 during 2021 (VBHC approach). The median age of the population was 63 (IQR 51-72), 23% of patients were classified as ASA 3 and 4, and 26.8% (2,955 cases) were day surgery cases. We found a considerable decrease in the number of preoperative tests ordered for each patient [6.2 (2.5) vs 5.3 (2.6) tests, p < 0.001]. The number of preoperative chest X-ray, electrocardiogram, and cardiac exams decreased significantly with VBHC. The length of the preoperative evaluation was significantly shorter with VBHC [373 (136) vs 290 (157) min, p < 0.001]. Cost analysis demonstrated a significant reduction in costs, while there was no difference in clinical outcomes.

CONCLUSIONS

We demonstrated the feasibility, safety, and cost-effectiveness of a tailored approach for preoperative evaluation. The implementation of VBHC enhanced value, as evidenced by decreased patient time in preoperative evaluation and by a reduction in unnecessary preoperative tests.

摘要

背景

基于价值的医疗保健（VBHC）是一种方法，侧重于为患者提供尽可能高的价值，同时提高卫生服务的成本效益。它强调在优化资源利用的同时改善患者结局和体验，将医疗保健系统的重点从服务量转移到所提供的价值上。我们的研究评估了实施基于VBHC原则的定制术前评估在改善患者护理和结局以及降低医疗保健成本方面的有效性。

方法

我们采用质量改进的前后对比方法，评估实施VBHC策略对胡马纳塔斯研究医院术前评估诊所重组的影响。干预措施在干预后阶段（2021年）引入了VBHC定制的风险矩阵，并将结果与干预前阶段（2019年）进行比较。主要研究结局是术前检查数量和就诊次数在基线时与采用VBHC方法后之间的差异。次要结局是患者结局和成本。

结果

共纳入9722例患者：2019年（基线）有5242例，2021年（VBHC方法）有4480例。人群的中位年龄为63岁（四分位间距51 - 72岁），23%的患者被分类为ASA 3级和4级，26.8%（2955例）为日间手术病例。我们发现每位患者术前检查的数量有显著减少[6.2（2.5）次对5.3（2.6）次检查，p < 0.001]。采用VBHC后，术前胸部X线、心电图和心脏检查的数量显著减少。采用VBHC后，术前评估的时长显著缩短[373（136）分钟对290（157）分钟），p < 0.001]。成本分析表明成本显著降低，而临床结局无差异。