Abstract
Introduction
Spending on hospital inpatients comprises a major proportion of healthcare costs. This study assessed the impact of systematic feedback to gastroenterologists on the cost of care provided to inpatients on a gastrointestinal/hepatology (GIH) hospital service.
Methods
Patients with a GIH diagnosis were randomly assigned to be cared for by one of two hospital services. Over 3 months, teams were randomized to receive feedback (GIH A) or no feedback (GIH B, control group); feedback consisted of an email sent twice weekly to all physicians on the GIH A service detailing the length of stay (LOS) and real-time cost of care accrued by each inpatient.
Results
Over 3 months, care was provided to 56 (GIH A) and 47 (GIH B) inpatients with a GIH illness. Patient complexity level was similar for both services as demonstrated by mean relative value: 1.11 (GIH A) vs. 1.27 (GIH B), p = 0.2. Weighted LOS and weighted cost of care values were calculated to adjust for the respective RV of each patient. Mean weighted LOS (10.8 [GIH A] vs. 13.8 days/pt [GIH B], p = 0.02) and mean weighted cost of care (9,904 [GIH A] vs. 12,654 euros/pt [GIH B], p = 0.02) were significantly lower in the feedback group. Subsequent hospital readmission rates did not differ among both groups.
Conclusion
Systematic feedback on cost of care was associated with lower healthcare costs without compromising quality. Incorporating a running total of patient costs into computer software used to order patient tests may represent one approach to controlling healthcare expenses.
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References
http://www.oecd.org/document/16/0,3746,en_2649_37407_2085200_1_1_1_37407,00.html
Newgard CD, Fleischman R, Choo E et al (2010) Validation of length of hospital stay as a surrogate measure for injury severity and resource use among injury survivors. Acad Emerg Med 17(2):142–150
Ko CW, Kelley K, Meyer KE (2001) Physician speciality and the outcomes and cost of admissions for end-stage liver disease. Am J Gastroenterol 96(12):3411–3418
Quirk DM, Barry MJ, Aserkoff B et al (1997) Physician speciality and variations in the cost of treating patients with acute upper gastrointestinal bleeding. Gastroenterology 113(5):1443–1448
Pardo A, Durandez R, Hernandez M et al (2002) Impact of physician speciality on the cost of nonvariceal upper GI bleeding care. Am J Gastroenterol 97(6):1535–1542
Armellino D, Hussain E, Schilling ME et al (2012) Using high technology to enforce low technology safety measures: the use of third party remote video auditing and real time feedback in healthcare. Clin Infect Dis 54(1):1–7
Nair BG, Newman SF, Peterson GN et al (2010) Feedback mechanisms including real-time electronic alerts to achieve near 100% timely prophylactic antibiotic administration in surgical cases. Anesth Analg 111(5):1293–1300
Sadasivam RS, Delaughter K, Crenshaw K et al (2011) Development of an interactive, Web-delivered system to increase provider-patient engagement in smoking cessation. J Med Internet Res 13(4):e87
Plotnikoff RC, Pickering MA, McCargar LJ et al (2010) Six-month follow-up and participant use and satisfaction of an electronic mail intervention promoting physical activity and nutrition. Am J Health Promot 24(4):255–259
Taheri PA, Butz DA, Greenfield LJ (2000) Length of stay has minimal impact on the cost of hospital admission. J Am Coll Surg 191(2):123–130
Slattery E, Harewood GC (2012) Speciality specific admission: a cost-effective intervention? Ir J Med Sci 181(1):87–91
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Slattery, E., Harewood, G.C., Clancy, K.X. et al. Randomized controlled trial of feedback on cost of hospital care among gastroenterology inpatients. Ir J Med Sci 182, 503–507 (2013). https://doi.org/10.1007/s11845-013-0923-0
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DOI: https://doi.org/10.1007/s11845-013-0923-0