f1 rapid fire: making sense of health care dollars - s. raschka
TRANSCRIPT
Health Economic Evaluation of Quality and Patient Safety within an Organization
Quality Forum 2012Breakout Session F1
March, 9th 2012
Stefanie RaschkaGraduate Student, University of Cologne
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Agenda
1. Background
2. Methods
3. Results
4. Discussion
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Agenda
1. Background
2. Methods
3. Results
4. Discussion
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1. Background
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Health Economic Evaluation of infection prevention and control programs
Economic burden of selected healthcare acquired infections
Identification of potential for greatest financial benefits, further improvements, and priority setting by reducing healthcare acquired infections
Evaluation of efficiency of regional quality and patient safety initiatives
Efficiency?
Economic outcome in a healthcare environment?
Is it worth it?
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Agenda
1. Background
2. Methods
3. Results
4. Discussion
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2. Methods2.1 Health Economic Evaluation
Health Economic Evaluation•Competition between resource scarcity and the best healthcare for the population•Economic outcome measurement, efficient use of resources, •Patient focused
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• Evaluation of costs and consequences in monetary units
Is an intervention worthwhile?
Cost-Benefit Analysis
• Comparative study design by using monetary and non-monetary units
• Benefits = natural units (e.g. hospital days prevented)
• Costs = monetary units
• Evaluation of different drug therapies
Cost-Effectiveness Analysis
• Comparative study design by using monetary and non-monetary units
• Outcome measurement in a unit of utility Eg. Quality adjusted life years (QALY)
Cost-Utility Analysis
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2. Methods2.2 Determining costs and benefits
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1.Cost/Benefit-Calculation:• Exact changes of infection rates from a moving baseline• Two cost categories: a) Cost for the treatment of selected HAIs &
b) Costs for infection prevention and control (IPC) programs
• “Savings” = Cost avoidance from infections
• Cost benefit a) Costs for each selected HAI – the cost avoidance for that HAI category b) Cost of the IPC program - Cost avoidance from infections
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2. Methods2.3 Selected Healthcare Acquired Infections
4. Selection of Projects:• Only a few of the overall infection prevention and control programs undertaken by
the QPS Department were analyzed• MRSA, UTI, CDI, VRE, Healthcare acquired Bacteremias, SSI• Only nosocomial incidence cases have been taken into analysis
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3. Meta-Analysis:• (Inter-) National studies and data as benchmarks• e.g. PICNet, IHI, CPSI, CNISP• PICNet Business case was used (as available) for estimated cost per infection,
adjusted costs to 2010/11 using an annual inflation factor of 3% per year
2. Organizational Perspective:• Calculations are based on internal data• Limited availability of data no disease specific cost data available
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Agenda
1. Background
2. Methods
3. Results
4. Discussion
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3. Results3.1 Evaluation of Costs
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Overall Expenditures on HAIs at VCH over the last four years
13.26
18.21
18.15
15.59
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2007-08 2008-09 2009-10 2010-11
Expe
nditu
res
in $
M.
VCH spent more than $ 65.2 M for the treatment of the selected HAIs over the last 4 years
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3. Results3.1 Evaluation of Costs
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UTI is the most common HAI at VCH with 18,900 cases over the last 4 years
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3. Results3.1 Evaluation of Costs
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UTI, VRE, Bacteremia and MRSA are the main cost drivers
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The total expenditures for the QPS Department were more than $ 11 M and $ 6.7 M for Infection Control over the last four years
The increased QPS costs reflect program expansion.
3. Results3.1 Evaluation of Costs
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3. Results3.2 Evaluation of “Savings”
VCH was able to generate overall “savings” of $ 8 M over the last 4 years
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46 % of overall savings have been generated by reducing UTI cases
3. Results3.2 Evaluation of Savings
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UTI, VRE, MRSA and Bacteremia have the most potential for further benefits
3. Results3.3 Overall Cost-Benefit Analysis
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3. Results3.3 Overall Cost-Benefit Analysis
SSIs, BSIs, MRSA and VRE have been identifies as the most expensive HAIs
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The overall savings by reducing the selected HAIs exceed the costs for infection prevention and control initiatives
3. Results3.3 Overall Cost-Benefit Analysis of the IPC program
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3. Results3.3 Overall Cost-Benefit Analysis
A break-even point of costs and savings was realized in the second year of evaluation
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Agenda
1. Background
2. Methods
3. Results
4. Discussion
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Potential priority setting on UTI, VRE, MRSA and Bacteremias
Extension of initiatives to all facilities (rural) Creation of further incentives to increase compliance rates
Potential and Priorities
Costs of $ 65 M for the treatment of the selected HAIs over a four year evaluation period
Costs of $ 11.2 M QPS / $ 6.7 M IPC compared to saving of $ 8.1 M by reducing 4,700 HAI cases
Break-even in the second year of evaluation
Economic burden
Availability and validity of data Collaborative team approach for quality
and patient safety initiatives Overall organizational benefit
Limitations
4. Discussion
Collaborators• Linda Dempster• Shane Busby• Elizabeth Bryce• Patrick O’Connor• Leslie Forrester• Catherine Pacero• Mark Chase