Premium
A pilot study assessing clinic value in pediatric pharyngeal dysphagia: The OPPS /cost method
Author(s) -
Coppess Steven,
Soares Jennifer,
Frogner Bianca K.,
DeMarre Kimberley,
Faherty Amy,
Hoang Jennifer,
Shah Mahek,
MacKin Matthew,
Johnson Kaalan
Publication year - 2019
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27552
Subject(s) - medicine , dysphagia , activity based costing , patient experience , health care , patient satisfaction , family medicine , medical emergency , emergency medicine , physical therapy , nursing , surgery , marketing , economics , business , economic growth
Objectives/Hypothesis Given the costs of healthcare, capitation, and desires for quality improvement (QI), there is a need to better assess healthcare value. Time‐driven activity‐based costing and the Quadruple Aim have evaluated value by assessing health outcomes and provider experiences relative to costs. The proposed OPPS/Cost method expands on this to examine value for aerodigestive clinic treatment of pediatric persistent pharyngeal dysphagia: O + P 1 + P 2 + S / Cost ( O = objective health [video‐fluoroscopic swallow study results], P 1 = patient/family experience [Consumer Assessment of Healthcare Providers and Systems], P 2 = provider experience [Copenhagen Burnout Inventory {CBI}], S = subjective health [Feeding/Swallowing‐Impact Survey], C = cost [time‐driven activity‐based costing]). Study Design Use of QI time data, surveys, and retrospective chart review for 56 patient encounters. Methods Staff interviews were used to develop process maps, and monetary values were assigned to activities. OPPS/Cost outcomes were normalized amongst variables, and composite values were calculated. Comparisons were made using a Student t test for pre‐ and postclinic relocation over a 14‐month period. Results Time reductions were check‐in (13 minutes/patient), rooming (21 minutes/patient), and providers (4 minutes/patient). Patient in‐room wait time increased (4 minutes/patient). The CBI identified burnout as an area for improvement. OPPS/Cost composite values increased by 14%, with a 1.7% cost reduction, improvement in objective and subjective health outcomes of 47.4% ( P < .05) and 7.3%, respectively, and stable patient/family experience. Conclusions OPPS/Cost is feasible in an interdisciplinary clinic and helped evaluate value during a clinic relocation. The QI opportunities identified are indicative of the potential of OPPS/Cost. Level of Evidence NA Laryngoscope , 129:1527–1532, 2019