value based health care in colorectal cancer surgery · source: nationwide outcomes measurement in...
TRANSCRIPT
Friday 31th of October
Value Based Health Care in Colorectal Cancer Surgery
Improving quality, reducing costs
J.A. Govaert AIOS Heelkunde
Opleiden in
Mini Symposium OOR Leiden Maandag 26 juni 2017
Korte introductie
Onderzoek en opleiding
Value Based Healthcare in Colorectal Cancer Surgery
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Definitie
Low quality High costs
High quality Low costs
Low quality Low costs
High quality High costs
Hea
lthca
re c
osts
-
+
Healthcare quality - +
2
Definitie
Low quality High costs
High quality Low costs
Low quality Low costs
High quality High costs
Hea
lthca
re c
osts
-
+
Healthcare quality - +
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Nurse Surgeon PA
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Doen we het dan zo slecht?
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Doen we het dan zo slecht?
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Moet het allemaal tegelijk?
Shared benefit (op weg naar bundled payment?)
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Dutch Value Based Healthcare Study
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Klinische gegevens
DSCA 2010 t/m2012
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Primaire colorectaal carcinoom waarvoor operatie en geregistreerd in de DSCA (dekking >97%)
Exclusie criteria o Ontbreken informatie over
• Tumor locatie
• Operatie datum
• Sterfte
Klinische uitkomsten tot 30 dagen na operatie en/of duur van opname
Financiële gegevens
Time-Driven Activity-Based Costing
Ziekenhuis kosten tot 90 dagen na ontslag
Exclusie:
• Specialisten honorarium
• Kosten medicatie
• Kosten dialyse
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Dutch Value Based Healthcare Study
Source: Costs of complications after colorectal cancer surgery in the Netherlands: Building the business case for hospitals. Govaert et al. EJSO 2015
5% of the most expensive patients are responsible for 23% of the total costs
5% of the most expensive patients are responsible for 23% of the total costs
Source: Costs of complications after colorectal cancer surgery in the Netherlands: Building the business case for hospitals. Govaert et al. EJSO 2015
Source: Costs of complications after colorectal cancer surgery in the Netherlands: Building the business case for hospitals. Govaert et al. EJSO 2015
Patients with complications are accountable for 31% of the total costs
Patients with complications are accountable for 31% of the total costs
Source: Costs of complications after colorectal cancer surgery in the Netherlands: Building the business case for hospitals. Govaert et al. EJSO 2015
Mean
Mea
n
Identification of ‘best practice’ hospitals (A)
Source: Nationwide Outcomes Measurement in Colorectal Cancer Surgery: Improving Quality and Reducing Costs. Govaert et al. JACS 2016
Source: Nationwide Outcomes Measurement in Colorectal Cancer Surgery: Improving Quality and Reducing Costs. Govaert et al. JACS 2016
Best performing hospitals
Improve potential hospitals
Mea
n
Improve potential hospitals: 9 hospitals, 3540 patients Best performing Hospitals: 12 hospitals, 3880 patients
Identification of ‘best practice’ hospitals (B)
Source: Nationwide Outcomes Measurement in Colorectal Cancer Surgery: Improving Quality and Reducing Costs. Govaert et al. JACS 2016
Source: Nationwide Outcomes Measurement in Colorectal Cancer Surgery: Improving Quality and Reducing Costs. Govaert et al. JACS 2016
Mean
Identification of ‘best practice’ hospitals (C)
Source: Nationwide Outcomes Measurement in Colorectal Cancer Surgery: Improving Quality and Reducing Costs. Govaert et al. JACS 2016
Source: Nationwide Outcomes Measurement in Colorectal Cancer Surgery: Improving Quality and Reducing Costs. Govaert et al. JACS 2016
Differences in costs between different risk groups should create awareness for healthcare providers and/ or payers
Source: Multicenter Stratified Comparison of Hospital Costs Between Laparoscopic and Open Colorectal Cancer Resections: Influence of Tumor Location and Operative Risk. Govaert et al. Annals of Surgery 2016
Colon cancer Rectal cancer
Source: Multicenter Stratified Comparison of Hospital Costs Between Laparoscopic and Open Colorectal Cancer Resections: Influence of Tumor Location and Operative Risk. Govaert et al. Annals of Surgery 2016
Cost difference between laparoscopic and open resections stratified by sub-group
Source: Multicenter Stratified Comparison of Hospital Costs Between Laparoscopic and Open Colorectal Cancer Resections: Influence of Tumor Location and Operative Risk. Govaert et al. Annals of Surgery 2016
Source: Multicenter Stratified Comparison of Hospital Costs Between Laparoscopic and Open Colorectal Cancer Resections: Influence of Tumor Location and Operative Risk. Govaert et al. Annals of Surgery 2016
Oudere geopereerde patiënt kost niet meer dan jongere patiënt
31 Source: Hospital Costs of Colorectal Cancer Surgery for the Oldest Old: A Dutch Population-Based Study. Govaert et al. JSO 2016
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Gedifferentieerd belonen?
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Lange opname loont
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85% verschil in kostprijs tussen verschillende risicogroepen
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Gedifferentieerd belonen?
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Concluderend
Vragen?
6 april 2016