DescriptionBackground: Starting in 2009, an effort to improve clinical outcomes and reduce costs in surgical procedures was initiated by the University of Applied Sciences in Upper Austria. Since 2015, eleven hospitals have taken part in this program, adding up to more than 75 % of beds in the county. As role models, systems were chosen which had been initiated by Intermountain Healthcare or the National Surgical Quality Improvement Program (NSQIP). The primary aim of this program was to introduce value-based care in participating hospitals and by doing so to optimize processes of care. Methods: In a multi enterprise effort to improve clinical outcomes and reduce costs, a management and reporting tool, “Rosetta Medical”, was developed which allows clinicians and managers to analyze actual costs and outcomes at the level of individual encounters and by department, diagnosis, and procedure. Data from hospital data bases (services provided for the patients during and 42 days before and after the stay, length of stay (LOS) as well as mortality) was combined with data (55 predefined pre-operative risk factors and complications) collected by specially trained nurses from handwritten patient documentation. Physicians were included in the data collection process to help ensure data quality. Variable costs were calculated on the basis of the costs of services provided for the patients as well as the length of stay. Results were compared on a risk-adjusted basis between the hospitals using logistic regression methods. Reports were presented and discussed on a quarterly basis in the presence of all the participating surgeons. Results: For the first time, it was possible to compare processes, outcome and costs on a risk- adjusted basis in Austrian hospitals of varying sizes. Significant variability in outcome, service ordering patterns (laboratory and radiologic as well as other services performed for the patients) as well as LOS or variable costs were demonstrated in the management of common surgical procedures. Conclusion: For the participating hospitals “Rosetta-Medical” provides a unique opportunity to compare their work on a fair and transparent basis. Transparency concerning outcome and processes of care enables collaborative initiatives to adopt evidence-based best practices.
|Period||2 Oct 2017|
|Event title||Isqua's 34th international Conference: null|