A new analysis led by researchers at UCSF shows that avoiding lowest-volume hospitals and maximizing adherence to quality care processes are both effective approaches to reducing costs associated with coronary bypass surgery.
The relationship between higher case volume and better outcomes of cardiac surgery is well established, while other efforts have focused on improving patient outcomes through adherence to quality care measures, according to the research team. However, the researchers state that few data exist describing the impact of case volume or quality measures on health care value - the combination of cost and quality of care.
In the study, which was adjusted for patient and site characteristics, lowest-volume hospitals had 19.8 percent higher costs than hospitals that saw higher numbers of patients, and adjusting for care quality did not eliminate differences in costs.
The researchers also determined that adherence to quality process measures resulted in cost savings and that maximizing overall performance on quality measures is critical. Individual quality measures had inconsistent associations with cost or length of stay in the hospital. However, patients for whom no quality measures were missed had much shorter hospital stays and lower costs than those for whom even one measure was missed.
Findings are available this week in the online edition of the Archives of Internal Medicine at http://archinte.ama-assn.org/cgi/content/full/170/14/1202.
"Improving quality and reducing costs of care are crucial goals for this country," said Andrew D. Auerbach, MD, MPH, an associate professor in the UCSF Division of Hospital Medicine and lead author of the paper. "In addition, consumers are being asked to make more of their own health care decisions based on the value of their care. The better we understand the relationships between the drivers of cost and quality, the more effective we can be in designing systems and incentives to improve care."