Leveraging Quality Improvement and Patient Safety Initiatives to Enhance Value and Patient-Centered Care in Otolaryngology

Brenner, Michael; Cramer, John D.; Cohen, Samantha T.; Balakrishnan, Karthik

doi:10.1007/s40136-018-0209-1

Cited by 3 publications

(4 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This latter question builds on the cost-outcome curve, which suggests that at a certain point, increased costs may be associated with worse outcomes or lower-quality care. 17 If specific system factors or patterns of care are associated with higher costs, they may provide avenues to reduce costs while maintaining quality of care, driving strategies to increase the value of the care we provide.…”

Section: Discussionmentioning

confidence: 99%

“…This exploratory study suggests much future work: more granular analysis of factors related to higher or lower costs of care, comparison of high‐ and low‐cost surgeons and centers, tracking of temporal trends in cost distributions, and analysis of whether higher‐cost patients are receiving more complex care and, if so, whether that cost can be justified by higher quality or better outcomes. This latter question builds on the cost‐outcome curve, which suggests that at a certain point, increased costs may be associated with worse outcomes or lower‐quality care 17 . If specific system factors or patterns of care are associated with higher costs, they may provide avenues to reduce costs while maintaining quality of care, driving strategies to increase the value of the care we provide.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Predictors of High Costs of Care among Otolaryngology Patients

Balakrishnan

Moriarty

Rosedahl

et al. 2019

Otolaryngol.--head neck surg.

Self Cite

View full text Add to dashboard Cite

Objectives Identify predictors of high-cost otolaryngology care. Study Design Cross-sectional. Setting Tertiary academic multispecialty hospital. Subjects/Methods All patients undergoing ≥1 otolaryngologic procedures from 2011 to 2015. Encounter costs were standardized using previously described methods approximating Medicare reimbursement. Patients were stratified by adult/pediatric and inpatient/outpatient. “Outliers” were defined as total encounter costs ≥95th percentile. Logistic regression measured predictors of outlier status. Results In total, 2433 adult inpatient encounters (95th percentile $57,611), 10,031 adult outpatient encounters ($10,772), 346 pediatric inpatient encounters ($84,639), and 3027 pediatric outpatient encounters ($8978) were included. For adult inpatient and outpatient, isolated head and neck oncologic procedures were the reference group. Among adult inpatients, laryngology and facial plastics procedures predicted higher odds of outlier status (odds ratio [OR] = 4.1 and 7.2). Involvement of multiple otolaryngology subspecialties increased the odds (OR = 4.7). Neck dissection and reconstructive procedures were the most common primary operations for adult inpatient outliers. For adult outpatients, several subspecialties had lower odds than head and neck (OR ≤0.44). Increased comorbidities predicted outliers for adult inpatient care (OR = 1.5); sex, age, race, and ethnicity did not. Cochlear implant was the most common primary operation among adult and pediatric outpatient outliers. Greater subspecialty involvement and increasing age predicted pediatric outpatient outliers (OR = 8.0 and 1.1); younger age and female sex predicted pediatric inpatient outliers (OR = 0.8 and 3.5). Airway procedures dominated pediatric inpatient outliers. Conclusion This is the first large-scale study of high-cost otolaryngology care across multiple subspecialties. Specific procedures and subspecialties and increased comorbidities predicted high-cost care. Contrary to previous studies, patient sex, race, and ethnicity did not.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictors of High Costs of Care among Otolaryngology Patients

Balakrishnan

Moriarty

Rosedahl

et al. 2019

Otolaryngol.--head neck surg.

Self Cite

View full text Add to dashboard Cite

show abstract

“…[9][10][11][12][13][14][15] These patients are susceptible to catastrophic complications, 9 and their care is resource intensive. 16 There is growing awareness of the urgent need to provide high-value medical care. 17,18 A tracheostomy is a powerful marker for medical complexity, independent of the numerous potential complications directly attributable to the device, stoma site, and aphonic state.…”

mentioning

confidence: 99%

“…The need to improve care in patients with tracheostomy is well documented 9–15 . These patients are susceptible to catastrophic complications, 9 and their care is resource intensive 16 . There is growing awareness of the urgent need to provide high‐value medical care 17 , 18 .…”

mentioning

confidence: 99%

The Trach Trail: A Systems‐Based Pathway to Improve Quality of Tracheostomy Care and Interdisciplinary Collaboration

Cherney

Pandian

Ninan

et al. 2020

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

Objective To implement a standardized tracheostomy pathway that reduces length of stay through tracheostomy education, coordinated care protocols, and tracking patient outcomes. Methods The project design involved retrospective analysis of a baseline state, followed by a multimodal intervention (Trach Trail) and prospective comparison against synchronous controls. Patients undergoing tracheostomy from 2015 to 2016 (n = 60) were analyzed for demographics and outcomes. Trach Trail, a standardized care pathway, was developed with the Iowa Model of Evidence-Based Practice. Trach Trail implementation entailed monthly tracheostomy champion training at 8-hour duration and staff nurse didactics, written materials, and experiential learning. Trach Trail enrollment occurred from 2018 to 2019. Data on demographics, length of stay, and care outcomes were collected from patients in the Trach Trail group (n = 21) and a synchronous tracheostomy control group (n = 117). Results Fifty-five nurses completed Trach Trail training, providing care for 21 patients placed on the Trach Trail and for synchronous control patients with tracheostomy who received routine tracheostomy care. Patients on the Trach Trail and controls had similar demographic characteristics, diagnoses, and indications for tracheostomy. In the Trach Trail group, intensive care unit length of stay was significantly reduced as compared with the control group, decreasing from a mean 21 days to 10 ( P < .05). The incidence of adverse events was unchanged. Discussion Introduction of the Trach Trail was associated with a reduction in length of stay in the intensive care unit. Realizing broader patient-centered improvement likely requires engaging respiratory therapists, speech language pathologists, and social workers to maximize patient/caregiver engagement. Implications for Practice Standardized tracheostomy care with interdisciplinary collaboration may reduce length of stay and improve patient outcomes.

show abstract