Integrated Care in a Large Public System Improves Simple Kidney Stone Management

Area of Science:

• Health Services Research
• Health Economics
• Urology

Background:

• The Los Angeles County Department of Health Services, a major public health system, utilizes clinical integration for collaborative specialty care.
• Comparing integrated and traditional care models is crucial for understanding efficiency and cost-effectiveness in managing kidney stones.

Purpose of the Study:

• To compare the patient burden and cost of kidney stone diagnosis, workup, and management between integrated and non-integrated care pathways.
• To evaluate the impact of clinical integration on the efficiency and cost of kidney stone care.

Main Methods:

• Employed time-driven activity-based costing to analyze costs associated with kidney stone care.
• Conducted interviews and observations to map workflows and identify resource requirements in both integrated and traditional models.
• Calculated the total cost per stone episode and the number of steps to surgical scheduling.

Main Results:

• The integrated pathway cost $499.04 per stone episode, versus $699.81 in the non-integrated pathway, a 29% cost reduction.
• Integrated care required 11 steps to operating room scheduling, compared to 14 steps in the traditional pathway.
• Demonstrated significant improvements in efficiency and cost reduction through clinical integration.

Conclusions:

• Clinical integration offers a more efficient and cost-effective model for kidney stone care from patient, provider, and health system viewpoints.
• Integrated care has the potential to improve access to specialty services, enhance care value, and lessen the patient treatment burden.