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The Clinical outcomes, healthcare resource utilization, and related costs (COHERENT) model. Application in heart

Héctor Bueno1, José L Bernal2, Víctor Jiménez-Jiménez3

  • 1Grupo de Investigación Cardiovascular Multidisciplinaria Traslacional, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.

Revista Espanola De Cardiologia (English Ed.)
|October 24, 2021
PubMed

Insights

The Clinical outcomes, healthcare resource utilization and related costs (COHERENT) model visually displays composite endpoints and costs. This new tool effectively compares patient groups and cohorts, aiding clinical trials and healthcare benchmarking.

Area of Science:

  • Health Services Research
  • Clinical Epidemiology
  • Health Economics

Background:

  • Composite endpoints are crucial in clinical research but have limitations.
  • Visualizing endpoint components (incidence, timing, duration) and costs is challenging.
  • The Clinical outcomes, healthcare resource utilization and related costs (COHERENT) model offers a novel visual approach.

Purpose of the Study:

  • To validate the COHERENT model in a real-world patient cohort.
  • To assess the model's ability to display composite endpoint components and associated costs.
  • To evaluate the COHERENT model's utility for comparing patient groups and healthcare systems.

Main Methods:

  • Developed a color graphic system to display patient clinical status and costs over time.
  • Hierarchically coded mutually exclusive clinical situations.
  • Tested the system on 1126 acute heart failure patients across 25 hospitals, analyzing 30-day outcomes and costs.

Main Results:

  • The COHERENT model visualized 30-day patient trajectories (e.g., alive at home, in ED, hospitalized, deceased).
  • Significant differences in outcomes and costs were observed between patient groups, hospitals, and healthcare systems.
  • Daily and cumulative healthcare costs were calculated, totaling over €4.8 million for the cohort.

Conclusions:

  • The COHERENT model provides an interpretable visual display for composite endpoints and costs.
  • It facilitates comparisons across patient groups and cohorts.
  • The model is a promising tool for clinical trials, observational studies, benchmarking, and value-based healthcare.
Abstract

Keywords:
Acute heart failureCOHERENT modelComposite outcomesCostCostesDays alive out of hospitalDías de vida fuera del hospitalEmergency departmentGraphical representationHospitalizaciónHospitalizationInsuficiencia cardiaca agudaModelo COHERENTReadmissionReingresosRepresentación gráficaResultados combinadosSalud basada en valorUrgenciasValue-based health care

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