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- Title
A pilot study assessing clinic value in pediatric pharyngeal dysphagia: The OPPS/cost method.
- Authors
Coppess, Steven; Soares, Jennifer; Frogner, Bianca K.; DeMarre, Kimberley; Faherty, Amy; Hoang, Jennifer; Shah, Mahek; MacKinnon, Matthew; Johnson, Kaalan
- Abstract
<bold>Objectives/hypothesis: </bold>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 + P1 + P2 + S/Cost (O = objective health [video-fluoroscopic swallow study results], P1 = patient/family experience [Consumer Assessment of Healthcare Providers and Systems], P2 = provider experience [Copenhagen Burnout Inventory {CBI}], S = subjective health [Feeding/Swallowing-Impact Survey], C = cost [time-driven activity-based costing]).<bold>Study Design: </bold>Use of QI time data, surveys, and retrospective chart review for 56 patient encounters.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.<bold>Level Of Evidence: </bold>NA Laryngoscope, 129:1527-1532, 2019.
- Subjects
COPENHAGEN (Denmark); INDIA. Central Bureau of Investigation; ACTIVITY-based costing; PEDIATRIC clinics; MEDICAL care wait times; DEGLUTITION disorders; COST control; EVALUATION of medical care; PILOT projects; RESEARCH; FERRANS &; Powers Quality of Life Index; RESEARCH methodology; RETROSPECTIVE studies; EVALUATION research; MEDICAL cooperation; COMPARATIVE studies; COST effectiveness; QUALITY assurance; IMPACT of Event Scale; QUESTIONNAIRES
- Publication
Laryngoscope, 2019, Vol 129, Issue 7, p1527
- ISSN
0023-852X
- Publication type
journal article
- DOI
10.1002/lary.27552