This prospective study defines how the implementation of the PB CD34 value results in costs savings. A low PB CD34 value canceled or postponed a significant number of leukapheresis procedures, resulting in a substantial cost savings. Use of the PB CD34 value should be the standard of care during mobilization and peripheral blood progenitor cell collection.
To promote patient education, the Dartmouth Bone Marrow Transplant (BMT) Program created a website focusing on Quality Reports, highlighting outcomes and patient satisfaction data. In an attempt to address areas most important to potential patients, the development of the website involved Transplant physicians and nurses, outside reviewers and recently transplanted patients. Based on these assessments and interviews, the BMT website was designed to provide various outcome data, including disease-specific overall- and disease-free survival, length of stay, and incidence of nausea. The website became public in January 2004. The use of the public website was evaluated 18 months after initiation. There was a 300% increase in external user visits to the Dartmouth BMT Website (comparing 3 month averages). Eighty percent of the information accessed was in the topic of “Safe and Effective Care”, which addresses patient-specific data, including survival statistics, length of stay, or toxicities during the transplant. The remaining 20% of interest was satisfaction measures addressing patients’ view of their overall care, opinions addressing nursing care or physician interaction. Of the top ten measures that were evaluated by users, the first 9 were disease-specific survival statistics and the remaining was “Average Length of Hospital Stay”. Individual interviews with patients (n=16) indicate that the information provided on the web site increased the trust of the institution. In addition, patients felt re-assured concerning their selection of our institution. In conclusion, the initiation of the Dartmouth BMT Quality Reports Website (http://www.dhmc.org/QualityReports) that focuses on outcome data resulted in a marked increased use of the Dartmouth BMT Website within 18 months. Patients were most interested in disease-specific survival statistics, followed by transplant patients’ opinions of their care. Patients report that the “transparency” of outcome results and the patient education provided by the website improve their trust of our BMT program/hospital and foster assurance of our institution’s reputation.
In order to contain costs, MDs must first identify the clinical factors contributing to increased resource utilization associated with an autologous stem cell transplant. We performed a retrospective clinical and cost analysis of all autologous transplants performed at Dartmouth- Hitchcock Medical Center over a 30 month period (2002-2004) and identified patients who had a prolonged length of stay > 25 d (PLOS). We pinpointed the clinical characteristics and hospital course of each patient to identify trends. The hospital cost-accounting system highlighted resource utilization and costs of the transplants, allowing a comparison between patients with a PLOS and all other transplant patients. PROLONGED LENGTH OF STAY (PLOS) Results: All Patients LOS < 25 days LOS > 25 days # of patients 87(100%) 58 (67%) 29 (33%) LOS (days) Mean (Median) 24 (22) 20 (20) 31 (31) DISEASE (n = no. of patients) AML 14 9 5 HD/NHL 44 24 20 MM 28 25 3 Other (ITP) 1 1 ENGRAFTMENT (median) ANC > 500 (Platelets > 20K) 12 (18) 11 (16) 13 (27) TRANSFUSIONS UNITS /PT (median) RBC /Platelets > 20 4 (3) 3 (2) 7 (7) PARENTAL NUTRITION (TPN) # of days (median) 9 6 14 TOXICITIES >= GRADE 3 NCI (Common Toxicitity Criteria) Nausea and Vomiting 36% 77% Diarrhea 9% 45% Mucositis 36% 41% Anorexia 57% 83% INFECTION RATE 10% 34% ICU TRANSFER 3% 3% Major contributors to costs included nursing/daily room charge costs (39%), pharmacy (39%), Blood Bank (6%), Laboratory (12%), and other costs (3%). The average daily costs are $4252. The PLOS cohort had grade > 3 toxicity, increased infection rate, engrafted later and required more transfusional support. 1 pt was transferred to the ICU for temporary management. Of the 29 patients identified with PLOS, none died and all were discharged from the hospital. 45% of NHL/HD patients experienced a prolonged LOS, representing 68% of the PLOS cohort. The median LOS<25d is 20d and the median LOS>25d is 30.5d. At an average daily cost of $4252, these additional 10.5 days of hospitalization costs are substantial. Based on these findings, identification of factors underlying PLOS in the NHL/HD cohort may provide the key to minimizing cost of autologous stem cell transplant. Accordingly, we are assessing the impact of age, number of pre-transplant treatment regimens, number of peripheral blood stem cells reinfused, use of IL-2 for post-transplant immune modulation, and the day 15 absolute lymphocyte count on LOS in this population.
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