f3 stefanie raschka - how to put a health economic lens on quality and patient safety programs
TRANSCRIPT
How to put a Health Economic Lens on Quality and Patient Safety Programs
Quality Forum 2013 Breakout Session F3
Friday, March 1st 2013
Stefanie Raschka, Dipl. MA
Health Economist Vancouver Coastal Health
Agenda
1. Background
2. Method
3. Examples
4. Take Aways
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1. Background
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Socio-Economic Challenges
• Increasing quality of care while decreasing costs
• Identifying efficient
methods to use scarce resources AND increasing quality of patient care at
the same time
Resource scarcity
Med-Tech progress
Demographic change
Quality Improvement
Resource Equity
1. Background
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Quality Variables:
Adverse Events & Occurrences, Patient & Employee Satisfaction
Procurement Best practices
Economic variables: Cost and benefits, Return-on-
Investment, Efficiency
Agenda
1. Background
2. Method
3. Examples
4. Take Aways
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• Evaluation of costs and
consequences in monetary units
• Opportunity Costs • Cost Avoidance Is an intervention
worthwhile?
Cost-Benefit Analysis
• Competition between resource scarcity and providing the best possible care • Economic outcome measurement, efficient use of resources • Patient focused • Long-term evaluation
Health Economic Evaluation
• Translate results into improved access to the system, e.g.
• Bed days / Patient days
• Wait times • Patient Volume
• Assess the potential of a quality improvement initiative before implementation
Projection Analysis
2. Methods Health Economic Evaluation
System Access
2. Methods Core Measurements
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3. Health Economics • Cost-Benefit Analysis • Return-on-Investment
• Cost Avoidance • Access (e.g. additional patient days, beds freed)
1. Quality Outcomes • Patient/Employee Satisfaction and
Experiences • Adverse Events / Occurrences • Healthcare Acquired Infections
• Mortality & Morbidity
4. Program Costs / Investments • Operational Costs
• Implementation Costs • Training and Education • Consultancy Support
2. Productivity & Efficiency • Length of Stay
• Admissions / Readmissions • Work Flow / Direct Care Time
• Employee Turnover and Staff Absence • Reducing Waste /Clutter-Free
Environment
Making “Cents“
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2. Methods Core Measurements – VCH Releasing Time to Care (RT2C)
Improve Patient Safety and Reliability of Care
• Infection rates (MRSA, UTI, C.diff…) • Hand hygiene compliance rate • In-hospital falls • Timing of meal tray delivery
Improve Patient Experience
• Acute care patient experience • Patient satisfaction survey
Improve Staff Well-Being
• Survey/Dot-voting • QI knowledge • Staff absence • Overtime
Improve Efficiency of Care
• Volume of patient admissions • Direct care time • Length of stay • Readmission rates • Materials and Stocking • Bed moves
Program costs: • Training and education
• Staff appointed to the RT2C program
• Equipment and Materials
Agenda
1. Background
2. Method
3. Examples
4. Take Aways
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3. Examples Surgical Quality Improvement
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1. Quality Outcome
Patient Experience
•30 Day Follow-up: Use of overall satisfaction
question: “How would you rate your overall surgical experience on a scale of 1 (being the
worst) and 5 (being the best) at…”
• Acute Care Inpatient
Survey Results
4.03 4.16
4.3 4.34 4.34 4.36
3.8
4
4.2
4.4
4.6
4.8
5
Mean Surgical Patient Satisfaction VCH
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3. Examples Surgical Quality Improvement
1. Quality Outcome
Physician & Staff Feedback Survey
•Impact of NSQIP* on collaboration, culture,
teamwork and communication
•48 face-to-face interviews
with front-line staff, physicians, administration,
quality coordinators
4.3
4
3.2
5.9
0 1 2 3 4 5 6
NSQIP is improving quality of surgical care
NSQIP has influenced communication
NSQIP has influenced culture
I see value in the program
VCH
Strongly Disagree
Strongly Agree
*National Surgical Quality Improvement Program (NSQIP)
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3. Examples Staff Satisfaction
1. Quality Outcome
Dot-Voting
•Pre- and Post- Implementation Surveys
• Measures the impact of the
quality improvement program on front-line staff
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3. Examples Direct Care Time
2. Productivity & Efficiency
Activity Follows
• Releasing time to patient care
• Reduce interruptions • Using “soft” lean management tools • Identify areas of
improvement • Collaborative team
approach
May - 2012 January - 2013
Direct Care Time 27 % 26 %
Direct Care Minutes 191 (of 720)
158 (of 600)
Interruptions per hour 15.75 10.0
Interrupted by someone else (interruption per hour)
10.65
7.5
Interrupted someone else (interruptions per hour)
5.1 2.5
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3. Examples Reducing Waste
2. Productivity & Efficiency
Clutter-free Environment
•Implementation of a de-clutter template
• The pilot inpatient units of
the CDI program at VGH found
$ 1,181 in supplies and materials wasted
$381
$134
$237
$5
$328
$10
$86
$-
$50
$100
$150
$200
$250
$300
$350
$400
Tape Swabs IV Setsand
Supplies
Gauze PersonalCareItems
Syringes Misc
32.2%
11.3%
20.1% 0.4%
27.8%
0.8% 7.3% Tape
Swabs
IV Sets and Supplies
Gauze
Personal Care Items
Syringes
Misc
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3. Examples Projected Reduction of In-hospital Falls
3. Health Economics
3 Demonstration Sites at Richmond Hospital 2012 Reduced by 50 %
Number of minor falls per year (30% ) 59 30 Number of moderate and severe harm falls (10%) 18 9
Costs (minor harm); $ 11,254 per case $ 663,983 $ 337,619
Costs (moderate and severe harm); $ 30,696 per case $ 552,528 $ 276,264
Total $ 1,216,511 $ 613,883
Cost Avoidance $ 602,629
Bed Days minor falls (extended LOS 4 days) 295 150 Bed Days moderate and severe harm falls (extended LOS 34 days) 612 306 Total Bed Days 907 456
Bed Days Avoided 451
Falls Prevention Actions
• Installed Y-connectors at each bed with bed alarms • Safety checks during each
shift • Risk assessment on
admission • Installation of motion
sensor lights • Family education for fall
prevention
What if we are reaching the goal of reducing falls by 50% ?
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3. Examples Enhanced Recovery After Surgery (ERAS)
3. Health Economics
Service Number of cases Bed days ALOS Reduction of LOS Bed days avoided Additional patients treated
General Surgery 3,235 28,843 9 2 days 6,198 885
Cardiac Surgery 951 10,256 11 4 days 3,599 514
Gyn/urological Surgery 2,748 8,428 4 2 days 2,932 1,466
Total 6,934 47,527 12,729 2,866
Using ERAS to Reduce Length of Stay
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3. Examples Enhanced Recovery After Surgery (ERAS)
3. Health Economics
Using ERAS to Reduce Post-op Complications*
Assumption: Median additional hospital costs for patients with complications = $ 4,000 Based on: Dimick JB, et al. "Complications and Costs after High-Risk Surgery". J Am Coll Surg. 2003. Vol 196, No 5.
Service Number of cases Complications Additional costs for
complications Reduction of complications
∆ Complications
Complications avoided
Costs avoided
General Surgery 2,837 463 $1,851,994 38% 287 176 $703,758 Colorectal 398 178 $710,032 27% 130 48 $191,709 Cardiac Surgery 951 231 $925,513.20 27% 169 62 $249,889 Gyn/urological Surgery 2,748 266 $1,065,124.80 20% 213 53 $213,025 Total 6,934 1,138 $4,552,664 799 340 $1,358,380
*The analysis is based on a one year period (2011/12). The occurrence rate for complication is based on NSQIP data reports.
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3. Examples Cost-Benefit Analysis of an Infection Prevention and Control Program 3. Health
Economics
$1.87
$3.87
$3.36
$1.60
$1.60
$1.80 $1.70
$-
$0.50
$1.00
$1.50
$2.00
$2.50
$3.00
$3.50
$4.00
$4.50
2007/08 2008/09 2009/10 2010/11
In $
M
Total "savings" Total operational costs IPC
Cost-Benefit Analysis
• $ 65 M spent for the treatment of the selected
HAIs over a four year evaluation period
(incl. MRSA, UTI, SSI, Bacteremias, VRE, CDI)
• Operational costs of
$ 6.7 M and $ 8.1 M in savings from
reducing 4,700 HAI cases
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3. Examples Return-on-Investment of Human Factors in Healthcare Procurement 3. Health
Economics
Return-on-Investment
•5-year lifecycle costs: $ 976,037
(incl. capital costs, costs for sets and replacement of pumps, educational
and costs for performing human factors evaluation)
• 5-year “savings”:
$ 2,314,960 (incl. savings on materials and
equipment, prevented adverse drug events, reduction of maintenance
time)
$0.00
$0.50
$1.00
$1.50
$2.00
$2.50
Year 1 Year 2 Year 3 Year 4 Year 5
In $
M
CostsBenefits
ROI ratio = savings : costs
ROI (5-years) = 2:1 ROI (10-years) = 5:1
Agenda
1. Background
2. Method
3. Examples
4. Take Aways
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4. Take Aways Lessons Learned
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Money Talks: • Identifies the economic burden, the potential for “savings” and the
areas of opportunity and priority setting
But, it’s not all about money: • Get the front-line’s experience and opinion (qualitative data) • Making sure the initiatives positively impact patient satisfaction
Use the opportunity to show the improvements: • Identify core measures at the beginning of a program or initiative • Include Before-AND-After evaluations
It’s a learning process and a long-term approach
Stefanie Raschka, MA Dipl. Health Economist
Quality & Patient Safety Vancouver Coastal Health
Email: [email protected] Phone: (604) 875-4111 ext. 21491
Cell: (604) 816-9550
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Thank you!
Collaborators • Patrick O’Connor • Linda Dempster • Elizabeth Bryce • Felicia Laing • Mary Cameron-Lane • Sarah Rothwell • VCH Quality & Patient Safety Team
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Backup
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