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Implementación de un programa de resultados basado en el valor para identificar la alta variabilidad en los costos y
Vivian S Lee1, Kensaku Kawamoto1, Rachel Hess1
1University of Utah, Salt Lake City.
JAMA
|September 14, 2016
Resumen
Una herramienta de resultados basados en el valor ayudó a reducir los costos de atención médica y a mejorar los resultados de los pacientes en proyectos clínicos específicos. Los médicos que entienden los costos reales y los resultados pueden mejorar la atención de los pacientes individuales.
Área de la Ciencia:
- Investigación en servicios de salud
- Economía de la salud
- Mejora de la calidad clínica
Sus antecedentes:
- El sistema de salud de EE.UU. está pasando de la atención basada en el volumen a la atención basada en el valor.
- La medición precisa de los costos y los resultados a nivel de cada paciente es crucial para esta transformación.
Objetivo del estudio:
- Evaluar el impacto de una herramienta de resultados basada en el valor en la reducción de costes y la optimización de los resultados en materia de salud.
- La herramienta asigna costos y medidas de calidad a encuentros individuales con pacientes.
Principales métodos:
- Un estudio no controlado, pre-post, longitudinal y observacional se realizó en la Universidad de Utah Health Care desde 2012 hasta 2016.
- Los médicos utilizaron una herramienta que proporciona datos sobre los resultados, los costos y la variación, en colaboración con expertos en mejora de procesos.
- Las métricas clave incluían los costes directos, la variabilidad de los costes (coeficiente de variación) y los índices de calidad compuestos.
Principales resultados:
- Para el reemplazo total de articulaciones, el índice de calidad mejoró del 54% al 80%, y los costos directos medios disminuyeron en un 11% después de la implementación.
- Los costos de las pruebas de laboratorio en los hospitales disminuyeron en 15 dólares por día.
- Para la sepsis, el tiempo medio hasta la administración de antiinfecciosos disminuyó en 4,1 horas.
Conclusiones:
- La implementación de una herramienta de resultados basada en el valor en un sistema de salud grande redujo los costos y mejoró la calidad en áreas clínicas seleccionadas.
- Proporcionar a los médicos datos reales de costos y resultados a nivel del paciente puede beneficiar la toma de decisiones clínicas y la prestación de atención.
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