Cost variation in a laparoscopic cholecystectomy and the association with outcomes across a single health system: implications for standardization and improved resource utilization
| Autor: | Bruce L. Hall, William G. Hawkins, David G. Brauer, David P. Jaques, Ryan C. Fields, L. Michael Brunt, Nicholas R. Mercurio, Steven M. Strasberg |
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| Rok vydání: | 2015 |
| Předmět: |
Operating Rooms
medicine.medical_specialty Quality management Standardization Cost-Benefit Analysis media_common.quotation_subject medicine.medical_treatment MEDLINE Context (language use) Surgical Equipment Cost Savings Humans Medicine Quality (business) Operations management Hospital Costs Practice Patterns Physicians' Disposable Equipment health care economics and organizations Quality Indicators Health Care Retrospective Studies media_common Missouri Hepatology Cost–benefit analysis business.industry Process Assessment Health Care Gastroenterology Retrospective cohort study Original Articles Quality Improvement Surgery Treatment Outcome Cholecystectomy Laparoscopic Health Resources Cholecystectomy business |
| Zdroj: | HPB. 17:1113-1118 |
| ISSN: | 1365-182X |
| DOI: | 10.1111/hpb.12500 |
| Popis: | Background Payers and regulatory bodies are increasingly placing emphasis on cost containment, quality/outcome measurement and transparent reporting. Significant cost variation occurs in many operative procedures without a clear relationship with outcomes. Clear cost‐benefit associations will be necessary to justify expenditures in the era of bundled payment structures. Methods All laparoscopic cholecystectomies (LCCKs) performed within a single health system over a 1‐year period were analysed for operating room (OR) supply cost. The cost was correlated with American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) outcomes. Results From July 2013 to June 2014, 2178 LCCKs were performed by 55 surgeons at seven hospitals. The median case OR supply cost was $513 ± 156. There was variation in cost between individual surgeons and within an individual surgeon's practice. There was no correlation between cost and ACS NSQIP outcomes. The majority of cost variation was explained by selection of trocar and clip applier constructs. Conclusions Significant case OR cost variation is present in LCCK across a single health system, and there is no clear association between increased cost and NSQIP outcomes. Placed within the larger context of overall cost, the opportunity exists for improved resource utilization with no obvious risk for a reduction in the quality of care. |
| Databáze: | OpenAIRE |
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