A pilot study assessing clinic value in pediatric pharyngeal dysphagia: The OPPS/cost method. (4th October 2018)

• Record Type: Journal Article
• Authors: Coppess, Steven; Soares, Jennifer; Frogner, Bianca K.; DeMarre, Kimberley; Faherty, Amy; Hoang, Jennifer; Shah, Mahek; MacKinnon, Matthew; Johnson, Kaalan
• Is Part Of: Laryngoscope. Volume 129:Number 7(2019)
• Page Start: 1527
• Page End: 1532
• Publication Date: 2018-10-04
• Subjects: Value -- quality improvement -- time‐driven activity‐based costing -- aerodigestive -- pharyngeal dysphagia; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.27552
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Objectives/Hypothesis: Given the costs of healthcare, capitation, and desires for quality improvement (QI), there is a need to better assess healthcare value. Time‐driven activity‐based costing and the Quadruple Aim have evaluated value by assessing health outcomes and provider experiences relative to costs. The proposed OPPS/Cost method expands on this to examine value for aerodigestive clinic treatment of pediatric persistent pharyngeal dysphagia: O + P 1 + P 2 + S / Cost ( O = objective health [video‐fluoroscopic swallow study results], P 1 = patient/family experience [Consumer Assessment of Healthcare Providers and Systems], P 2 = provider experience [Copenhagen Burnout Inventory {CBI}], S = subjective health [Feeding/Swallowing‐Impact Survey], C = cost [time‐driven activity‐based costing]). Study Design: Use of QI time data, surveys, and retrospective chart review for 56 patient encounters. Methods: Staff interviews were used to develop process maps, and monetary values were assigned to activities. OPPS/Cost outcomes were normalized amongst variables, and composite values were calculated. Comparisons were made using a Student t test for pre‐ and postclinic relocation over a 14‐month period. Results: Time reductions were check‐in (13 minutes/patient), rooming (21 minutes/patient), and providers (4 minutes/patient). Patient in‐room wait time increased (4 minutes/patient). The CBI identified burnout as an area for improvement. OPPS/Cost composite values increased by 14%, with a 1.7% cost reduction, improvement in objective and subjective health outcomes of 47.4% ( P < .05) and 7.3%, respectively, and stable patient/family experience. Conclusions: OPPS/Cost is feasible in an interdisciplinary clinic and helped evaluate value during a clinic relocation. The QI opportunities identified are indicative of the potential of OPPS/Cost. Level of Evidence: NA Laryngoscope, 129:1527–1532, 2019