One hospital's multifaceted effort to inform physicians about the costs and quality of their care successfully lowered costs of joint replacement, resulted in faster care for sepsis, and reduced laboratory expenses.
The pre-post observational study was conducted at University of Utah Health Care between 2012 and 2016. Researchers developed a tool to measure the actual cost of care (rather than charges) and convey that information to treating physicians. They also measured the variability of cost for different conditions and had clinicians select measures of quality of care. All these data were used to provide regular, comparative feedback to clinicians. Five pilot improvement projects were launched, and results from 3 (hip and knee replacement, hospitalist lab utilization, and sepsis) were reported in the Sept. 13 JAMA.
The researchers developed a composite index to measure the quality of total joint replacement and found that it improved from 54% at baseline to 80% after 1 year of the intervention (absolute change, 26%; 95% CI, 18% to 35%; P<0.001). Joint replacement costs also improved, by 7% during the implementation year and 11% the year after. The study also found reductions in hospitalists' lab costs, from a mean of $138 per day at baseline to $123 per day under the intervention, with no significant change in mean length of stay. For sepsis patients, the time to antibiotic administration was reduced, from 7.8 hours after meeting systemic inflammatory response syndrome criteria at baseline to 3.6 hours under the intervention.
The study authors concluded that their multifaceted tool succeeded in improving the value of care in 3 areas that showed high cost variation at baseline. “There may be benefit for individual physicians to understand actual care costs (not charges) and outcomes achieved for individual patients with defined clinical conditions,” they wrote. The authors noted several key components for improvement identified in this and other research, including regular feedback, clear targets, supportive tools, leadership focus, and multidisciplinary teams.
An accompanying editorial said this study “could not be more timely” given current pressures to improve the value of hospital care. The editorialists noted the importance of the intervention's finding specific areas where cost and value can be improved and focusing efforts on them, for example, modifying physical therapists' schedules so that they can get joint replacement patients out of bed on the day of surgery.