Improved outcomes and cost savings for patients with bleeding disorders: a quality improvement project.

Autor: Merrill SA; Department of Medicine, Section of Hematology/Oncology, West Virginia University School of Medicine, Morgantown, West Virginia, USA., Webber SE; Department of Medicine, Section of Hematology/Oncology, West Virginia University School of Medicine, Morgantown, West Virginia, USA., Merrill LJ; Department of Obstetrics and Gynecology, Weirton Medical Center, Weirton, West Virginia, USA., Shmookler AD; Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA.
Jazyk: angličtina
Zdroj: Research and practice in thrombosis and haemostasis [Res Pract Thromb Haemost] 2024 Apr 03; Vol. 8 (3), pp. 102401. Date of Electronic Publication: 2024 Apr 03 (Print Publication: 2024).
DOI: 10.1016/j.rpth.2024.102401
Abstrakt: Background: Providing optimal care for patients with bleeding disorders according to national standards remains a challenge at designated Hemophilia Treatment Centers (HTCs). Improved care may reduce bleeds and costs.
Objectives: To improve care and demonstrate cost savings by 1) reducing preventable hospitalizations and emergency room visits (PHER) for bleeding, 2) increasing use of prophylaxis in severe hemophilia, and 3) improving patient-HTC communication and primary care engagement.
Methods: Prospective quality improvement project using the Define, Measure, Analyze, Improve, and Control methodology to implement uniform guideline-based bleeding disorder care at a rural HTC ( N  = 88). Intervention used a standardized physician checklist, improved communication, and reserved physician time for urgent management. Outcomes were determined by retrospective chart review; urgent management was tracked prospectively.
Results: Intervention significantly reduced PHER by 85.4%. Use of prophylaxis in persons with severe hemophilia increased from 58.8% to 100%; attainment of a primary care physician and electronic portal enrollment met outcomes for intervention success. HTC clinic visit attendance was low at 55.2%. The majority of patients (71.6%) had at least 1 outpatient urgent episode (mean, 0.72 episode per year), and 93% had nonurgent management (mean, 9.3 episodes per year) occurring outside of a clinic visit. Hospital PHER factor cost in the group was reduced by 94.5%, from $11,800 to $640 per patient per year-a cost savings of $982,088 yearly.
Conclusion: This collaborative study shows that implementation of a carefully designed quality improvement project, such as uniform guidelines with focus on strengthening ambulatory management, led to improved outcomes and cost savings.
(© 2024 The Authors.)
Databáze: MEDLINE
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