Quality and Cost in Thoracic Surgery

Medbery, Rachel L.; Force, Seth D.

doi:10.1016/j.thorsurg.2017.03.006

Cited by 12 publications

(5 citation statements)

References 38 publications

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“…A good structure could improve a good process and in turn could improve a good outcome. Therefore, it was possible to construct a causal model in which each factor was a necessary condition for the next factor [27].…”

Section: Discussionmentioning

confidence: 99%

contribution of alignment between cost of quality improvement activities and quality achievements on efficiency in hospital

Nuryadi

Suhariadi

Pudjirahardjo

2022

ijhs

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An alignment between two or more aspect in hospitals could have an impact on efficiency. The results of a preliminary study at 9 regional general hospitals showed an inefficient 66.67% in 2015-2016, and there was a decrease in efficiency 33.33% of the inefficient hospital. The purpose of this paper is to analyze the contribution of alignment between the costs of quality improvement activities and quality achievements on efficiency in hospital. This study is an observational analytic research with survey method. The population of this study is general hospitals (government and private) class B and C in East Java of 150 units with a sample of 30 hospitals. Respondents for the alignment assessment are 432 people, while for the efficiency measurement are 118 people. Analysis to determine the contribution of alignment on efficiency using linear regression statistical test. The results showed that most hospitals were in an align between the cost of quality improvement activities with quality achievement of 70%, most of the hospitals were in the efficient of 60%, and the contribution of alignment between the costs of quality improvement activities and quality achievement on efficiency (RoS /CoS ratio) of 4.1% with a value of R² = 0.041.

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Section: Discussionmentioning

confidence: 99%

contribution of alignment between cost of quality improvement activities and quality achievements on efficiency in hospital

Nuryadi

Suhariadi

Pudjirahardjo

2022

ijhs

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“…However, it is right in surgery where the maximization of the ratio between outcomes and costs could lead to a major improvement. To date, no studies have been conducted to evaluate the applicability of VBHC in thoracic surgery, even if efforts for hospital-wide solutions that allows to maximize effectiveness, efficiency and timeliness of treatments are mandatory in our field ( 13 , 14 ). Our project goal was to direct the improvement and integration of processes at our department towards the recognition of the value generated, by adopting an embryonic VBHC approach.…”

Section: Introductionmentioning

confidence: 99%

Multi-level analysis and evaluation of organizational improvements in thoracic surgery according to a Value-Based HealthCare approach

Orlandi¹,

Scarci²,

Cioffi³

et al. 2023

J Thorac Dis

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Background: Value-Based HealthCare (VBHC), designed by Harvard University, is an evolving model of healthcare delivery that achieves better patient outcomes and greater financial sustainability for the healthcare professionals. According to this innovative approach, the value is determined by a panel of indicators and the ratio between results and costs. Our goal was to develop a panel of thoracic-fashioned keyperformance indicators (KPIs) creating a model that could be applied in thoracic surgery for the first time, reporting our early experience.Methods: Fifty-five indicators were developed based on literature review: 37 for outcomes and 18 for costs.Outcomes were measured by a 7 level Likert scale, while overall costs were defined through the sum of the individual economic performance on each resource indicator. An observational retrospective cross-sectional study was designed to make a cost-effective evaluation of the indicators. Therefore, the Patient Value in Thoracic Surgery (PVTS) score calculated value gained for every lung cancer patient undergoing lung resection at our surgical department.Results: A total of 552 patients were enrolled. From 2017 to 2019 mean outcome indicators per patient were 109, 113 and 110 while mean costs per patient were 7.370, 7.536 and 7.313 euros respectively. Hospital stay and waiting time from consultation to surgery for lung cancer patients decreased from 7.3 to 5 and from 25.2 to 21.9 days, respectively. On the contrary, number of patients increased but overall costs decreased, despite cost of consumables has gone from 2.314 to 3.438 euros, since cost of hospitalization and occupancy of the operating room (OR) improved (from 4.288 to 3.158 euros). Variables analyzed showed that overall value delivered grew from 14.8 to 15. Conclusions:Introducing a new concept of value, the VBHC theory applied to thoracic surgery may revolutionize traditional organizational management in lung cancer patients, showing how value delivered can increase in accordance with outcomes, despite the growth of part of the costs. Our panel of indicators has been created to provide an innovative score to successfully identify improvements needed and quantify their effectiveness in Thoracic Surgery and our early experience reports encouraging results.

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“…Thoracic surgery tends to involve one-lung ventilation, long operation times, increased trauma, sternum or rib incision, nerve injury, and acute or chronic pain. As these characteristics lead to many complications and seriously affect the prognosis of patients, PPCs of thoracic surgery have been widely studied by surgeons and anesthesiologists ( Hoshikawa & Tochii, 2017 ; Khaitan & D’Amico, 2018 ; Medbery & Force, 2017 ; Munoz De Cabo et al., 2020 ). The incidence of PPCs after thoracic surgery is 19–59% ( Agostini et al, 2010 ; Garcia-Miguel, Serrano-Aguilar & Lopez-Bastida, 2003 ).…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a nomogram to predict postoperative pulmonary complications following thoracoscopic surgery

Wang

Chen

Zhao

et al. 2021

PeerJ

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Background Postoperative pulmonary complications (PPCs) after thoracoscopic surgery are common. This retrospective study aimed to develop a nomogram to predict PPCs in thoracoscopic surgery. Methods A total of 905 patients who underwent thoracoscopy were randomly enrolled and divided into a training cohort and a validation cohort at 80%:20%. The training cohort was used to develop a nomogram model, and the validation cohort was used to validate the model. Univariate and multivariable logistic regression were applied to screen risk factors for PPCs, and the nomogram was incorporated in the training cohort. The discriminative ability and calibration of the nomogram for predicting PPCs were assessed using C-indices and calibration plots. Results Among the patients, 207 (22.87%) presented PPCs, including 166 cases in the training cohort and 41 cases in the validation cohort. Using backward stepwise selection of clinically important variables with the Akaike information criterion (AIC) in the training cohort, the following seven variables were incorporated for predicting PPCs: American Society of Anesthesiologists (ASA) grade III/IV, operation time longer than 180 min, one-lung ventilation time longer than 60 min, and history of stroke, heart disease, chronic obstructive pulmonary disease (COPD) and smoking. With incorporation of these factors, the nomogram achieved good C-indices of 0.894 (95% confidence interval (CI) [0.866–0.921]) and 0.868 (95% CI [0.811–0.925]) in the training and validation cohorts, respectively, with well-fitted calibration curves. Conclusion The nomogram offers good predictive performance for PPCs after thoracoscopic surgery. This model may help distinguish the risk of PPCs and make reasonable treatment choices.

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Quality and Cost in Thoracic Surgery

Cited by 12 publications

References 38 publications

contribution of alignment between cost of quality improvement activities and quality achievements on efficiency in hospital

contribution of alignment between cost of quality improvement activities and quality achievements on efficiency in hospital

Multi-level analysis and evaluation of organizational improvements in thoracic surgery according to a Value-Based HealthCare approach

Development and validation of a nomogram to predict postoperative pulmonary complications following thoracoscopic surgery

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