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Population requirements for capitation planning in pediatric cardiac surgery
J T Davis1, H D Allen, J D Powers
1Deparment of Surgery, The Ohio State University, College of Medicine, Children's Hospital, Columbus, USA.
Insights
A population of 1 million generates enough pediatric cardiac surgeries for accurate resource prediction. Smaller populations require individualized payment due to case mix variability.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Pediatric Healthcare
Background:
- Accurate prediction of resource utilization in pediatric cardiac surgery is crucial for healthcare management.
- Clinical pathways based on acuity, not diagnosis, facilitate resource tracking.
Purpose of the Study:
- To determine the minimum population size needed to generate sufficient pediatric cardiac surgeries for reliable resource utilization prediction.
- To assess the impact of patient group size on the predictability of resource needs.
Main Methods:
- Retrospective analysis of 750 pediatric cardiac surgical patients assigned to acuity-based clinical pathways.
- Subdivision of patient groups into sizes ranging from 150 down to 35 to examine variability.
- Extrapolation using state-wide pediatric cardiac surgery statistics to estimate required population base.
Main Results:
- A population base of 1 million generates approximately 100 pediatric cardiac operations.
- Groups of 100 or more patients demonstrated minimal variation in pathway distribution, enabling accurate hospital charge prediction.
- Groups of 50 or fewer patients showed significant variability, hindering accurate resource prediction.
Conclusions:
- Resource utilization for pediatric cardiac surgery can be accurately predicted for populations of 1 million covered lives (100 procedures) or more in a capitated setting.
- Populations of 500,000 covered lives or less necessitate individualized payment mechanisms due to high case mix variability.
Objective:
To determine the population number necessary to generate a sufficient volume of pediatric cardiac surgeries to allow accurate prediction of resource utilization.
Design:
All pediatric cardiac surgical patients receive care in our institution by means of only four clinical pathways that are based on acuity, not diagnosis or procedure. This allows accurate tracking of resource utilization. Based on available information, 750 consecutive surgically treated patients were retrospectively assigned to a pathway. They were subsequently subdivided into study groups of decreasing sizes from 150 to 35. Variability of pathway distribution from group to group was examined as a measure of the ability to predict resource utilization based on group size. Pediatric cardiac statistics from the state of Ohio were then used to extrapolate to the population base necessary to generate each group size.
Setting:
A regional pediatric cardiac referral center.
Patients:
All sequential patients who underwent pediatric cardiac surgery between July 1991 and January 1994.
Results:
Statewide statistics showed that a population base of 1 million people generates 100 pediatric cardiac operations. Groups of 100 patients or greater had minimal variation in pathway distribution from group to group, allowing accurate prediction of hospital charges. This was not true for groups of 50 patients or less.
Conclusions:
Resource utilization for pediatric cardiac surgery can be accurately predicted in a capitated setting for populations of 1 million covered lives (100 procedures) or greater. For populations of 500 000 covered lives or less, variability of case mix is great enough to suggest the need for a more individualized payment mechanism.