A pilot study assessing clinic value in pediatric pharyngeal dysphagia: The OPPS/cost method

Abstract

Objectives/Hypothesis: Given the costs of healthcare, capitation, and desires for quality improvement (QI), there is a need to better assess healthcare value. Time-driven activity-based costing and the Quadruple Aim have evaluated value by assessing health outcomes and provider experiences relative to costs. The proposed OPPS/Cost method expands on this to examine value for aerodigestive clinic treatment of pediatric persistent pharyngeal dysphagia: O + P 1 + P 2 + S/Cost (O = objective health [video-fluoroscopic swallow study results], P 1 = patient/family experience [Consumer Assessment of Healthcare Providers and Systems], P 2 = provider experience [Copenhagen Burnout Inventory {CBI}], S = subjective health [Feeding/Swallowing-Impact Survey], C = cost [time-driven activity-based costing]).Study Design: Use of QI time data, surveys, and retrospective chart review for 56 patient encounters. Methods: Staff interviews were used to develop process maps, and monetary values were assigned to activities. OPPS/ Cost outcomes were normalized amongst variables, and composite values were calculated. Comparisons were made using a Student t test for pre-and postclinic relocation over a 14-month period.Results: Time reductions were check-in (13 minutes/patient), rooming (21 minutes/patient), and providers (4 minutes/patient). Patient in-room wait time increased (4 minutes/patient). The CBI identified burnout as an area for improvement. OPPS/Cost composite values increased by 14%, with a 1.7% cost reduction, improvement in objective and subjective health outcomes of 47.4% (P < .05) and 7.3%, respectively, and stable patient/family experience.Conclusions: OPPS/Cost is feasible in an interdisciplinary clinic and helped evaluate value during a clinic relocation. The QI opportunities identified are indicative of the potential of OPPS/Cost.

Characterization of combined endoscopies and aerodigestive care: An analysis of utilization and financial feasibility

“…The organizational support within the infrastructure of coordinated care centers allows for more efficient and equitable use of combined procedures. We know that combining procedures is more cost effective [1,2,8,[13][14][15][16] and the data from this paper supports this. Therefore, improving coordinated care relies upon organizational support.…”

“…Additionally, hospitals in the Northeast had the greatest number of total procedures in comparison to other regions, but the smallest proportion of combined procedures. The utilization of combined procedures compared to airway or GI only procedures has not reached its maximum potential—the proportion of patients undergoing procedures in the same encounter is still quite low for what one would expect given the number or proportion of patients considered appropriate for multidisciplinary aerodigestive care [ 12 , 13 , 16 ].…”

“…This combined procedure is also associated with improved targeted interventions and post-intervention health, for patients with and without diagnoses following the procedure [ 17 ]. Aerodigestive centers show similar benefits to other care coordination models for improved patient outcomes, patient satisfaction, cost, and innovation [ 1 , 2 , 8 , 13 – 16 ].…”

“…Furthermore, multi-disciplinary teams have positive financial implications for care centers. The improved efficiency afforded by multi-disciplinary teams and the same factors that benefit patients, such as reduced anesthetic exposures and length of hospital admissions, result in significant positive cost margins for many centers and insurance payers [1,2,8,[13][14][15][16].…”