A Validated Value-based Model To Improve Hospitalwide Perioperative Outcomes
Thanjavur S Ravikumar1, *Cordelia Sharma1, *Garry Ritter2, *Corrado Marini1, *Rafael Barrera2, *Mimi Kim3, *Kathy Vandervoort4, *Marcella DeGermino2, *Lindsay Baker4, *Peter Levi4
1Geisinger Health System, Wilkes-Barre, PA;2LIJ Medical Center, New Hyde Park, NY;3Albert Einstein College of Medicine, Bronx, NY;4Montefiore Medical Center, Bronx, NY
OBJECTIVE(S): ): We hypothesized that building safe hospital systems to improve value-based surgical outcomes is predicated on workflow redesign for dynamic risk stratification, coupled with “real time” mitigation of risk.
METHODS: Prospective implementation of “Surgical Continuum of Care” (SCOC) model: Interdisciplinary team rounds, acuity stratified care rounding based on dynamic risk score, intensivist/hospitalist co management of surgical patients and targeted response.
Study: Pre-and Post-intervention with concurrent cohort control design. Setting: Academic Medical Centers. Patient Groups: Pilot Study - Campus A: Pre-intervention Control Group (PCG) 1998-2000, Intervention Group (IG) 2001-2004; Campus B: Comparator Control Group (CCG) 1998-2004. Validation Study - Campus C: Pre-intervention Group (PG-V) 2001-2005; Intervention Group (IG-V) 2006-2008. Metrics: Mortality, Length of Stay (LOS), cost; overall, SICU and Progressive Care Unit (PCU); Case Mix Index (CMI) for risk adjustment. Analysis: Regression, ANOVA, Fischer, chisquare, student t-test.
RESULTS: See table. Total >100,000 admissions. CMI unchanged during study in each campus. SICU, PCU and total hospital patient-days significantly decreased in IG group (p<0.05) reflecting enhanced throughput. In addition to decreased LOC, cost savings were in PCU ($1.74M/yr) and top DRGs (eg) $452K/yr. Nested study in validation cohort of hospital wide vs. surgery alone (observed/expected mortality index) demonstrated significant benefit to SCoC.
CONCLUSIONS: SCoC is patient-centered, outcomes-driven, value-based approach for hospital wide surgical patient safety. The principles of this value paradigm are adaptable to other hospitals.