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Clinical impact of a value-based decision: a surgical case study
John R Kirkpatrick1, Bruce M Smith, John L Zapas
1Department of Surgery, Georgetown University School of Medicine, Washington, DC 20016, USA. jrkcdk1@aol.com
Journal of the American College of Surgeons
|January 30, 2013
Summary
Implementing a single best practice for deep venous thrombophlebitis (DVT) prophylaxis across hospitals significantly increased value and offered substantial cost savings opportunities, demonstrating the power of value-based analysis in healthcare.
Area of Science:
- Healthcare Management
- Health Economics
- Clinical Practice Guidelines
Background:
- Value in healthcare is defined by quality and cost; value-based analysis identifies best practices (BPs) for optimal benefit.
- Healthcare systems employ value-based analysis to pinpoint BPs that enhance quality and reduce costs concurrently.
Purpose of the Study:
- To test the hypothesis that adopting a single best practice (BP) for deep venous thrombophlebitis (DVT) prophylaxis can improve value and reduce costs.
- To identify and compare current DVT prophylaxis practices across multiple hospitals within an integrated system.
Main Methods:
- A literature review identified BPs for DVT prophylaxis.
- Clinical outcomes (mortality, morbidity) and treatment costs were measured for DVT prophylaxis at 8 hospitals.
- The potential cost savings from adopting a single BP were calculated.
Main Results:
- Literature suggests BPs for DVT prophylaxis include sequential compression devices, unfractionated heparin, and low molecular weight heparin.
- Four hospitals adhered to these BPs; others used variations.
- Clinical outcomes were consistent across all hospitals, regardless of prophylaxis method.
Conclusions:
- Significant variation exists in DVT prophylaxis methods among hospitals, with no discernible impact on patient outcomes.
- Adopting a single best practice for DVT prophylaxis demonstrated a potential to increase value and achieve substantial cost savings, estimated at $1.5 million with a total opportunity of nearly $4 million.
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