An analytic tool that allocates clinical care costs and quality measures to individual patient encounters may help to enhance the quality of care delivered by physicians, according to research published in JAMA.
As reimbursement shifts from volume- to value-based, better and more sophisticated quality metrics are required to track patient costs and outcomes. Vivian S Lee, MD, PhD, MBA, University of Utah, Salt Lake City, and colleagues conducted a study measuring quality and outcomes relative to cost from 2012 to 2016 at University of Utah Health Care. Clinical improvement projects included total hip and knee join replacement, hospitalist laboratory utilization, and management of sepsis. Physicians were given access to a tool with information about outcomes, costs, and variation relative to the different procedures.
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In all, there were 1.7 million total patient visits and 34,000 inpatient dischargers during the study period. For total joint replacement, the composite quality index was 54% at baseline and 80% one year after the implementation of the quality programs. In addition, compared with the baseline year, mean direct costs were 7% lower in the implementation year and 11% lower in the post-implementation year.
The costs associated with laboratory testing were $138 at baseline and $123 in the evaluation period, but there was no significant change in mean length of stay.
A sepsis intervention program also helped to reduce the average time to anti-infective administration following fulfillment of systemic inflammatory response syndrome criteria in patients with infection (7.8 hours at baseline vs 3.6 hours in the evaluation period).
“Implementation of a multifaceted value-driven outcomes tool to identify high variability in costs and outcomes in a large single health care system was associated with reduced costs and improved quality for 3 selected clinical projects. There may be benefit for individual physicians to understand actual care costs (not charges) and outcomes achieved for individual patients with defined clinical conditions,” the authors of the study concluded.
Michael E Porter, PhD, Harvard Business School (Boston, MA), also praised the findings in an editorial published along side the study.
"The study by Lee and colleagues in this issue of JAMA is an impressive and important step forward, not just for the University of Utah Health Care system but for the rest of U.S. health care and other health care systems around the world that are focused on value,” Dr Porter wrote. “The findings offer proof of concept that improving value by patient condition can lead to lower costs and better quality—at the same time. There is much to be done and the road is long, but the report by Lee and colleagues points out how the path begins."
