Clinical Process Cost Analysis

Marrin, Charles A.S.; Johnson, Lisa G.; Beggs, V.; Batalden, Paul B.

doi:10.1016/s0003-4975(97)00526-2

Cited by 18 publications

(8 citation statements)

References 4 publications

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“…In a study conducted on minority patients who underwent various inpatient surgeries, BMI has been associated with increased hospital costs due to surgical difficulties and consequent longer use of the operating room [17]. Moreover, operating duration has been associated with about 40% of total hospital costs, with an average cost of $30 per minute in colorectal surgical procedures [9,18]. Based on our results, it would thus cost an additional $834 on average to operate on a morbidly obese patient compared with a normal one for a general elective colorectal procedure based on duration alone.…”

Section: Discussionmentioning

confidence: 99%

Body mass index predicts operative time in elective colorectal procedures

Saiganesh

Stein

Poggio

2015

Journal of Surgical Research

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Section: Discussionmentioning

confidence: 99%

Body mass index predicts operative time in elective colorectal procedures

Saiganesh

Stein

Poggio

2015

Journal of Surgical Research

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“…34 -38 One study has shown that the greatest costs associated with elective surgery are incurred the day of surgery and the first postoperative day 39 ; this, however, does not take into account the development of complications. Other studies have shown that complications after major surgery increase hospital costs.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Prolonged Length of Stay After Major Elective Surgery

Collins

Daley²,

Henderson³

et al. 1999

Annals of Surgery

411

260

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ObjectiveLength of stay (LOS) is an important outcome as a marker of resource consumption. Determining which factors increase LOS may provide information on reducing costs and improving the delivery of care. The purpose of this study was to determine the independent association of intraoperative process of care and postoperative events with prolonged LOS after adjusting for preoperative severity of illness in patients undergoing major elective surgery. MethodsCases representing 11 elective operations from the National VA Surgical Quality Improvement Program were analyzed using multivariate logistic regression analysis. The outcome, prolonged LOS, was defined as an LOS greater than or equal to the 75th percentile (in days) for each operation. Hierarchical modeling was used to assess the independent association of groups of variables (preoperative patient characteristics, intraoperative process of care, and postoperative adverse events) with prolonged LOS. ResultsFor the 11 operations explored, there were 23,919 cases. Common preoperative variables associated with prolonged LOS were functional status, American Society of Anesthesiology class, and age. The most predictive intraoperative and postoperative variables included intraoperative blood transfusion, operative time, return to the operating room, and the number of complications after surgery. ConclusionsProlonged LOS is associated with preoperative, intraoperative, and postoperative factors. Although preoperative factors were independently associated with a prolonged LOS, the factors generating the highest risks for a prolonged LOS were the intraoperative process of care and postoperative adverse events. To reduce costs, efforts should be made to improve the intraoperative process of care and to minimize postoperative complications.The health care system has received much attention in recent years as efforts are made to reduce costs while maintaining or improving the quality of care.1-5 Studying outcomes has been one method of evaluating health care delivery. One commonly measured outcome of interest is length of stay (LOS). 6 Patients with a prolonged LOS have substantially increased resource consumption.7 Several studies have addressed the risk factors for poor outcomes for surgical conditions, with emphasis on cardiac surgery. 8 -15 Because surgical services represent approximately 40% of all hospital expenses, and elective operations are far more common than emergent operations, 16 it is important to study further those factors related to poor outcomes in elective noncardiac surgery. Identifying which factors are associated with prolonged LOS for elective surgery will provide information on how to improve the delivery of perioperative care and reduce costs.The association between preoperative factors such as age,

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“…Process assessment in these approaches (e.g. [33,34]) mostlyf ocuses on financial improvement. The costsfor each activity arerecorded(e.g.…”

Section: 11i Nformalmethodsmentioning

confidence: 99%

“…The costsfor each activity arerecorded(e.g. averagem aintenancec osts), summarized for the whole process andc omparedw ith the financial income of the department or hospital [33]. This is done by controlling or at ask forceo fd omain experts [ 34].…”

Section: 11i Nformalmethodsmentioning

confidence: 99%

Supporting the Systematic Assessment of Clinical Processes: the MedFlow Method

Saboor

Chimiak-Opoka²,

Ammenwerth³

2007

Methods Inf Med

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Summary Objectives: Healthcare is characterized by complex cooperation between highly specialized healthcare departments. This often leads to inefficient clinical processes. In orderto improve these processes, a systematic assessment method is needed. Such methods are still missing. The objective of this paper is to propose and evaluate a method to support the systematic and semi-automatic assessment of clinical processes, with special focus on the quality of information logistics. Methods: Criteria for the quality of information logistics were collected based on literature research and system analysis. Appropriate quality checks for these criteria were developed. An extended process modelling notation was developed. The method was evaluated in a pilot study. Results: An own model integrates four sub-models with each concentrating on distinct process aspects (i.e., control flow, data flow, tool usage, organizational information). In orderto assess the quality of a process, selected process details are combined in “views”. Weak points are then detected by applying specific rule-sets on these views. Each rule-set represents a pattern of critical cross-points which are searched for in the appropriate view-matrix. The MedFlow method was evaluated in a first pilot study in radiological departments – applying quality checks for the detection of e.g. media cracks or testing the transcription of information objects. Conclusion: The MedFlow method is best used to assess clinical processes regarding their control flow and information handling. The latter directly influences the quality of communication and thusthe quality of whole processes. However, this must be evaluated in further studies.

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Clinical Process Cost Analysis

Cited by 18 publications

References 4 publications

Body mass index predicts operative time in elective colorectal procedures

Body mass index predicts operative time in elective colorectal procedures

Risk Factors for Prolonged Length of Stay After Major Elective Surgery

Supporting the Systematic Assessment of Clinical Processes: the MedFlow Method

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