BeschreibungObjectives: Starting in 2015, an effort to improve clinical outcomes and reduce costs in surgical procedures was initiated by the University of Applied Sciences in Upper Austria. The primary aim of this programme was to introduce value-based care in participating hospitals and by doing so to optimize processes of care. In a first step, surgical, orthopedic and urological Patients were included. To be able to provide all the clinical departments of the participating hospitals with data, a web based management and reporting tool for all surgical patients was developed. Methods: In a multi clinic effort to improve clinical outcomes and reduce costs, a web based management and reporting tool was developed, which allows clinicians and managers to analyze actual costs, processes of care and outcomes at the level of individual encounters and by department, diagnosis, and procedure. Data from hospital databases (risk factors, services provided for the patients during and 30 days before and after the stay, length of stay (LOS) as well as mortality) is provided on a web-based platform on a monthly basis. All post-surgical patients can be included into the system. For a proportion of patients, complicated cases were identified through specially trained nurses from handwritten patient documentation. For the rest of the patients, machine learned models were developed to automatically detect post-operative complications. Hence, cases with a high probability of complications could be detected. Physicians were included in the data collection process to help ensure data quality. Results: Throughout all the chosen surgical procedures in different department types, high variability in service ordering patterns (laboratory, radiologic and other services performed for the patients) as well as LOS or variable costs could be demonstrated in the management of common surgical procedures in 11 hospitals over a two-year period. For instance, mean costs for patients undergoing cholezystectomy (n=3057) were 1.3-5.1 times greater than the lowest rates in different departments. Complication rates varied between 4.1% and 15.5 % and LOS between a mean (min-max) 6.5 (3-43) and 8.9 days (3-54). Costs for patients undergoing thyreoidectomy (n=1116) were 1.1–3.2 times greater and costs for patients undergoing hernia repair (n=3464) were 1.8–4.1 times greater than the lowest rates. Complication rates varied for thyreoidectomy between 25.5% and 48.4% and for hernia repair between 2.4% and 9%. LOS varied between a mean (min-max) 5.3 (4-25) to 6.9 days (5-13) in thyreoidectomy and a mean (min-max) 2.5 (1- 37) to 4.9 (1-37) days in hernia repair. Conclusion: For the participating hospitals, the newly developed web-based benchmarking platform “Rosetta” provides a unique opportunity to compare their work on a fair and transparent basis. As the data flow is automated, it offers an inexpensive solution for benchmarking of post-surgical patients across medical departments and institutions. Other hospitals are invited to add their data, join the platform and gain access to anonymized data from their peers.
|Zeitraum||21 Okt 2019|
|Ereignistitel||ISQua`s 36th International Conference|