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Clinical Variation Reduction in Propensity-matched Patients Treated for Malignant Pleural Effusion
Richard K Freeman1, Kody Wyant2, Anthony J Ascioti1
1Division of Thoracic and Cardiovascular Surgery, St Vincent Hospital, Indianapolis, Indiana.
Background:
The potential advantages of clinical variation reduction are improved patient outcomes and cost reduction through optimizing and standardizing care. Malignant pleural effusion (MPE) is a common condition encountered by thoracic surgeons that has significant variation in cost and outcomes. The purpose of this investigation was to assess the opportunity of improving patient outcomes and reducing cost by using a standardized treatment algorithm based on evidenced-based care.
Methods:
Patients treated for MPE using a standardized treatment algorithm at the study institution over a 2 year period were identified and propensity matched to MPE patients from 1 of 6 affiliated hospitals with comprehensive oncology and thoracic surgery services. Matched patients were treated at their physicians' discretion. Factors used in propensity matching were age, performance status, and tumor histology. The 2 cohorts were then compared for interventions, admissions and readmissions, morbidity, and pleural effusion-associated costs. Patients who desired only comfort or hospice care were excluded.
Results:
From 2016 through 2018, 60 patients were treated using the standardized algorithm. These patients were propensity matched and the 2 cohorts compared. Patients treated with the algorithm experienced significantly fewer hospital admissions, readmissions, interventions, and costs while having a comparable procedural morbidity.
Conclusions:
An evidence-based treatment algorithm for MPE produces superior clinical outcomes to individualized therapy while significantly reducing the costs of care.
Insights
Standardizing care for malignant pleural effusion (MPE) through an evidence-based algorithm improves patient outcomes and reduces hospital costs. This approach optimizes treatment for MPE patients, leading to fewer admissions and interventions.
Area of Science:
- Thoracic Surgery
- Oncology
- Health Services Research
Background:
- Malignant pleural effusion (MPE) presents significant variation in patient outcomes and healthcare costs.
- Reducing clinical variation can enhance patient outcomes and lower costs by standardizing care.
- Optimizing and standardizing MPE treatment is crucial for improving patient care and resource allocation.
Purpose of the Study:
- To evaluate the impact of a standardized, evidence-based treatment algorithm for MPE.
- To assess the potential for improving patient outcomes and reducing costs associated with MPE management.
- To compare the effectiveness of a standardized algorithm versus individualized care for MPE.
Main Methods:
- A propensity-matched cohort study comparing patients treated with a standardized MPE algorithm to those receiving individualized care.
- Data collected over a two-year period from a single institution and six affiliated hospitals.
- Key matching factors included age, performance status, and tumor histology; outcomes assessed were interventions, admissions, morbidity, and costs.
Main Results:
- Patients treated with the standardized algorithm showed significantly fewer hospital admissions and readmissions.
- The algorithm group experienced a significant reduction in interventions and associated costs.
- Procedural morbidity was comparable between the algorithm-treated group and the individualized care group.
Conclusions:
- An evidence-based treatment algorithm for MPE significantly improves clinical outcomes compared to individualized therapy.
- Standardized care pathways for MPE lead to substantial reductions in healthcare costs.
- Implementing standardized algorithms is a viable strategy for optimizing MPE management.
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