Evaluation of an Intervention to Reduce Low-Value Preoperative Care for Patients Undergoing Cataract Surgery at a Safety-Net Health System
| Autor: | Cheryl L. Damberg, Jesse L. Berry, Catherine A. Sarkisian, Patricia Godoy-Travieso, Eric K. Wei, Joseph A. Ladapo, Emmett B. Keeler, Malvin Anders, Sitaram Vangala, John N. Mafi, Rodolfo Amaya, Laura Sarff, Carmen Carrillo, Lauren Patty Daskivich |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Psychological intervention Cataract Extraction Logistic regression 01 natural sciences Preoperative care California Cataract 03 medical and health sciences Electrocardiography 0302 clinical medicine Cost Savings Intervention (counseling) Anesthesiology Preoperative Care Internal Medicine medicine Humans 030212 general & internal medicine 0101 mathematics Original Investigation Aged business.industry Diagnostic Tests Routine Medical record 010102 general mathematics Fee-for-Service Plans Health Care Costs Cataract surgery Middle Aged Quality Improvement Logistic Models Emergency medicine Eye disorder Female Radiography Thoracic Capitation Fee business Safety-net Providers |
| Popis: | IMPORTANCE: Preoperative testing for cataract surgery epitomizes low-value care and still occurs frequently, even at one of the nation’s largest safety-net health systems. OBJECTIVE: To evaluate a multipronged intervention to reduce low-value preoperative care for patients undergoing cataract surgery and analyze costs from various fiscal perspectives. DESIGN, SETTING, AND PARTICIPANTS: This study took place at 2 academic safety-net medical centers, Los Angeles County and University of Southern California (LAC-USC) (intervention, n = 469) and Harbor–UCLA (University of California, Los Angeles) (control, n = 585), from April 13, 2015, through April 12, 2016, with 12 additional months (April 13, 2016, through April 13, 2017) to assess sustainability (intervention, n = 1002; control, n = 511). To compare pre- and postintervention vs control group utilization and cost changes, logistic regression assessing time-by-group interactions was used. INTERVENTIONS: Using plan-do-study-act cycles, a quality improvement nurse reviewed medical records and engaged the anesthesiology and ophthalmology chiefs with data on overuse; all 3 educated staff and trainees on reducing routine preoperative care. MAIN OUTCOMES AND MEASURES: Percentage of patients undergoing cataract surgery with preoperative medical visits, chest x-rays, laboratory tests, and electrocardiograms. Costs were estimated from LAC-USC's financially capitated perspective, and costs were simulated from fee-for-service (FFS) health system and societal perspectives. RESULTS: Of 1054 patients, 546 (51.8%) were female (mean [SD] age, 60.6 [11.1] years). Preoperative visits decreased from 93% to 24% in the intervention group and increased from 89% to 91% in the control group (between-group difference, −71%; 95% CI, –80% to –62%). Chest x-rays decreased from 90% to 24% in the intervention group and increased from 75% to 83% in the control group (between-group difference, −75%; 95% CI, –86% to –65%). Laboratory tests decreased from 92% to 37% in the intervention group and decreased from 98% to 97% in the control group (between-group difference, −56%; 95% CI, –64% to –48%). Electrocardiograms decreased from 95% to 29% in the intervention group and increased from 86% to 94% in the control group (between-group difference, −74%; 95% CI, –83% to −65%). During 12-month follow-up, visits increased in the intervention group to 67%, but chest x-rays (12%), laboratory tests (28%), and electrocardiograms (11%) remained low (P |
| Databáze: | OpenAIRE |
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