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Value-based assessment of implementing a Pulmonary Embolism Response Team (PERT)
Rahul Annabathula1, Adam Dugan2, Vikas Bhalla3
1College of Medicine, University of Kentucky, Lexington, KY, USA.
Insights
Pulmonary Embolism Response Teams (PERTs) improved patient care by reducing mortality and hospital stays. This multidisciplinary approach also significantly lowered the total cost of care, enhancing overall value.
Area of Science:
- Pulmonary Medicine
- Healthcare Management
- Cardiology
Background:
- Pulmonary Embolism Response Teams (PERTs) represent a novel, multidisciplinary strategy for managing pulmonary embolism (PE).
- PERTs aim to optimize patient identification, risk stratification, and care standardization for PE.
- Further research is needed to evaluate the impact of PERTs on PE care quality and outcomes.
Purpose of the Study:
- To assess the impact of a PERT on the quality and value of care for patients with acute pulmonary embolism.
- To compare patient outcomes and costs between pre-PERT and post-PERT implementation eras.
Main Methods:
- Retrospective study of adult patients with acute PE from January 2010 to December 2018.
- Exclusion of patients lacking imaging studies (CTPA or ECHO).
- Stratification into pre-PERT (before Oct 2015) and post-PERT (after Oct 2015) groups, considering right heart strain on imaging.
Main Results:
- Analysis included 530 patients (226 pre-PERT, 304 post-PERT).
- Significant improvements observed post-PERT: in-hospital mortality decreased (16.5% to 9.6%) and hospital length of stay (LOS) reduced (7.7 to 4.4 days).
- Total cost of care also demonstrated a statistically significant decrease post-PERT implementation.
Conclusions:
- Implementation of a PERT led to significant improvements in the quality and cost-effectiveness of pulmonary embolism care.
- These findings suggest PERTs enhance patient value through potentially faster diagnosis, risk stratification, and streamlined interventions.
- Further validation in larger patient cohorts is warranted to confirm these benefits.
Abstract:
PERTs are a new, multidisciplinary approach to PE care. They were conceived to efficiently identify and risk stratify PE patients and standardize care delivery. More research needs to be conducted to assess the effects that PERTs have had on PE care. This study sought to determine the effects of a PERT on quality and overall value of care. This was a retrospective study of all patients 18 years of age or older who presented with a principal diagnosis of an acute PE based on available ICD codes from January 1, 2010 to December 31, 2018. Patients who did not have an imaging study, i.e., CTPA or ECHO, available were excluded. Patients were divided into pre- (before October 2015) and post-PERT eras (after October 2015) and stratified based on the presence of right heart strain/dysfunction on imaging. All quality outcomes were extracted from the EMR, and cost outcomes were provided by the financial department. 530 individuals (226 pre-PERT and 304 post-PERT) were identified for analysis. Quality outcomes improved between the eras; most notably in-hospital mortality decreased (16.5 vs. 9.6) and hospital LOS decreased (7.7 vs. 4.4) (p < 0.05). Total cost of care also decreased a statistically significant amount between the eras. The implementation of a PERT improved quality and cost of care, resulting in improved value. We hypothesize that this may be due to more timely identification and risk stratification leading to earlier interventions and streamlined decision making, but further research is required to validate these findings in larger cohorts.
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