Does Anesthesia Quality Improvement Participation Lead to Incremental Savings in a Surgical Quality Collaborative Population? A Retrospective Observational Study.

Autor:	Janda AM; From the Departments of Anesthesiology., Vaughn MT; From the Departments of Anesthesiology., Colquhoun DA; From the Departments of Anesthesiology., Mentz G; From the Departments of Anesthesiology., Buehler K; From the Departments of Anesthesiology., Nathan H; Surgery, Michigan Medicine, Ann Arbor, Michigan., Regenbogen SE; Surgery, Michigan Medicine, Ann Arbor, Michigan., Syrjamaki J; Michigan Value Collaborative (MVC), Department of Surgery, Michigan Medicine, Ann Arbor, Michigan., Kheterpal S; From the Departments of Anesthesiology., Shah N; From the Departments of Anesthesiology.
Jazyk:	angličtina
Zdroj:	Anesthesia and analgesia [Anesth Analg] 2023 Nov 01; Vol. 137 (5), pp. 1093-1103. Date of Electronic Publication: 2023 Sep 06.
DOI:	10.1213/ANE.0000000000006565
Abstrakt:	Background: The Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) Collaborative Quality Initiative (CQI) was launched as a partnership among hospitals to measure quality, review evidence-based practices, and improve anesthesia-related outcomes. Cost savings and improved patient outcomes have been associated with surgical CQI participation, but the impact of an anesthesia CQI on health care cost has not been thoroughly assessed. In this study, we evaluated whether participation in an anesthesia CQI led to health care savings. We hypothesized that ASPIRE participation is associated with reduced total episode payments for payers and major, high-volume procedures included in the Michigan Value Collaborative (MVC) registry. Methods: In this retrospective observational study, we compared MVC episode payment data from Group 1 ASPIRE hospitals, the first cluster of 8 Michigan hospitals to join ASPIRE in January 2015, to non-ASPIRE matched control hospitals. MVC computes price-standardized, risk-adjusted payments for patients insured by Blue Cross Blue Shield of Michigan Preferred Provider Organization, Blue Care Network Health Maintenance Organization, and Medicare Fee-for-Service plans. Episodes from 2014 comprised the pre-ASPIRE time period, and episodes from June 2016 to July 2017 constituted the post-ASPIRE time period. We performed a difference-in-differences analysis to evaluate whether ASPIRE implementation was associated with greater reduction in total episode payments compared to the change in the control hospitals during the same time periods. Results: We found a statistically significant reduction in total episode (-$719; 95% CI [-$1340 to -$97]; P = .023) payments at the 8 ASPIRE hospitals (N = 17,852 cases) compared to the change observed in 8 matched non-ASPIRE hospitals (N = 12,987 cases) for major, high-volume surgeries, including colectomy, colorectal cancer resection, gastrectomy, esophagectomy, pancreatectomy, hysterectomy, joint replacement (knee and hip), and hip fracture repair. In secondary analyses, 30-day postdischarge (-$354; 95% CI [-$582 to -$126]; P = .002) payments were also significantly reduced in ASPIRE hospitals compared to non-ASPIRE controls. Subgroup analyses revealed a significant reduction in total episode payments for joint replacements (-$860; 95% CI [-$1222 to -$499]; P < .001) at ASPIRE-participating hospitals. Sensitivity analyses including patient-level covariates also showed consistent results. Conclusions: Participation in an anesthesiology CQI, ASPIRE, is associated with lower total episode payments for selected major, high-volume procedures. This analysis supports that participation in an anesthesia CQI can lead to reduced health care payments. Competing Interests: Conflicts of Interest: See Disclosures at the end of the article. (Copyright © 2023 International Anesthesia Research Society.)
Databáze:	MEDLINE
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