这不仅仅是价格:在三个国际站点开始静脉-静脉体外膜氧合的时间驱动的基于活动的成本-一个案例回顾

M. Nurok, V. Pellegrino, M. Pineton de Chambrun, J. Warsh, M. Young, E. Dong, N. Parrish, S. Shehab, A. Combes, R. Kaplan
{"title":"这不仅仅是价格:在三个国际站点开始静脉-静脉体外膜氧合的时间驱动的基于活动的成本-一个案例回顾","authors":"M. Nurok, V. Pellegrino, M. Pineton de Chambrun, J. Warsh, M. Young, E. Dong, N. Parrish, S. Shehab, A. Combes, R. Kaplan","doi":"10.1213/ANE.0000000000006074","DOIUrl":null,"url":null,"abstract":"The United States spends more for intensive care units (ICUs) than do other high-income countries. We used time-driven activity-based costing (TDABC) to analyze ICU costs for initiation of veno-venous extracorporeal membrane oxygenation (VV ECMO) for respiratory failure to estimate how much of the higher ICU costs at 1 US site can be attributed to the higher prices paid to ICU personnel, and how much is caused by the US site’s use of a higher cost staffing model. We accompanied our TDABC approach with narrative review of the ECMO programs, at Cedars-Sinai (Los Angeles), Hôpital Pitié-Salpêtrière (Paris), and The Alfred Hospital (Melbourne) from 2017 to 2019. Our primary outcome was daily ECMO cost, and we hypothesized that cost differences among the hospitals could be explained by the efficiencies and skill mix of involved clinicians and prices paid for personnel, equipment, and consumables. Our results are presented relative to Los Angeles’ total personnel cost per VV ECMO patient day, indexed at 100. Los Angeles’ total indexed daily cost of care was 147 (personnel: 100, durables: 5, and disposables: 42). Paris’ total cost was 39 (26% of Los Angeles) (personnel: 12, durables: 1, and disposables: 26). Melbourne’s total cost was 53 (36% of Los Angeles) (personnel: 32, durables: 2, and disposables: 19) (rounded). The higher personnel prices at Los Angeles explained only 26% of its much higher personnel costs than Paris, and 21% relative to Melbourne. Los Angeles’ higher staffing levels accounted for 49% (36%), and its costlier mix of personnel accounted for 12% (10%) of its higher personnel costs relative to Paris (Melbourne). Unadjusted discharge rates for ECMO patients were 46% in Los Angeles (46%), 56% in Paris, and 52% in Melbourne. We found that personnel salaries explained only 30% of the higher personnel costs at 1 Los Angeles hospital. Most of the cost differential was caused by personnel staffing intensity and mix. This study demonstrates how TDABC may be used in ICU administration to quantify the savings that 1 US hospital could achieve by delivering the same quality of care with fewer and less-costly mix of clinicians compared to a French and Australian site. Narrative reviews contextualized how the care models evolved at each site and helped identify potential barriers to change.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":"{\"title\":\"It’s Not Just the Prices: Time-Driven Activity-Based Costing for Initiation of Veno-Venous Extracorporeal Membrane Oxygenation at Three International Sites—A Case Review\",\"authors\":\"M. Nurok, V. Pellegrino, M. Pineton de Chambrun, J. Warsh, M. Young, E. Dong, N. Parrish, S. Shehab, A. Combes, R. Kaplan\",\"doi\":\"10.1213/ANE.0000000000006074\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"The United States spends more for intensive care units (ICUs) than do other high-income countries. We used time-driven activity-based costing (TDABC) to analyze ICU costs for initiation of veno-venous extracorporeal membrane oxygenation (VV ECMO) for respiratory failure to estimate how much of the higher ICU costs at 1 US site can be attributed to the higher prices paid to ICU personnel, and how much is caused by the US site’s use of a higher cost staffing model. We accompanied our TDABC approach with narrative review of the ECMO programs, at Cedars-Sinai (Los Angeles), Hôpital Pitié-Salpêtrière (Paris), and The Alfred Hospital (Melbourne) from 2017 to 2019. Our primary outcome was daily ECMO cost, and we hypothesized that cost differences among the hospitals could be explained by the efficiencies and skill mix of involved clinicians and prices paid for personnel, equipment, and consumables. Our results are presented relative to Los Angeles’ total personnel cost per VV ECMO patient day, indexed at 100. Los Angeles’ total indexed daily cost of care was 147 (personnel: 100, durables: 5, and disposables: 42). Paris’ total cost was 39 (26% of Los Angeles) (personnel: 12, durables: 1, and disposables: 26). Melbourne’s total cost was 53 (36% of Los Angeles) (personnel: 32, durables: 2, and disposables: 19) (rounded). The higher personnel prices at Los Angeles explained only 26% of its much higher personnel costs than Paris, and 21% relative to Melbourne. Los Angeles’ higher staffing levels accounted for 49% (36%), and its costlier mix of personnel accounted for 12% (10%) of its higher personnel costs relative to Paris (Melbourne). Unadjusted discharge rates for ECMO patients were 46% in Los Angeles (46%), 56% in Paris, and 52% in Melbourne. We found that personnel salaries explained only 30% of the higher personnel costs at 1 Los Angeles hospital. Most of the cost differential was caused by personnel staffing intensity and mix. This study demonstrates how TDABC may be used in ICU administration to quantify the savings that 1 US hospital could achieve by delivering the same quality of care with fewer and less-costly mix of clinicians compared to a French and Australian site. Narrative reviews contextualized how the care models evolved at each site and helped identify potential barriers to change.\",\"PeriodicalId\":7799,\"journal\":{\"name\":\"Anesthesia & Analgesia\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Anesthesia & Analgesia\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1213/ANE.0000000000006074\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Anesthesia & Analgesia","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1213/ANE.0000000000006074","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 1

摘要

美国在重症监护病房(icu)上的支出高于其他高收入国家。我们使用时间驱动的基于作业的成本法(TDABC)来分析针对呼吸衰竭启动静脉-静脉体外膜氧合(VV ECMO)的ICU成本,以估计1个美国站点的ICU成本增加中有多少可归因于ICU人员支付的较高价格,以及有多少是由于美国站点使用较高成本的人员配置模型造成的。在TDABC方法的同时,我们对2017年至2019年在Cedars-Sinai(洛杉矶)、Hôpital Pitié-Salpêtrière(巴黎)和Alfred医院(墨尔本)的ECMO项目进行了叙述性回顾。我们的主要结果是每日ECMO成本,我们假设医院之间的成本差异可以通过参与临床医生的效率和技能组合以及人员、设备和消耗品的支付价格来解释。我们的结果是相对于洛杉矶每个VV ECMO患者日的总人员成本,索引为100。洛杉矶的总指数每日护理成本为147(人员:100,耐用品:5,一次性用品:42)。巴黎的总成本为39英镑(是洛杉矶的26%)(人员12人,耐用品1人,一次性用品26人)。墨尔本的总成本为53(洛杉矶的36%)(人员:32,耐用品:2,一次性用品:19)(四舍五入)。洛杉矶较高的人力成本仅占其比巴黎高得多的人力成本的26%,比墨尔本高21%。与巴黎(墨尔本)相比,洛杉矶更高的员工水平占到49%(36%),其更昂贵的人员组合占到12%(10%)的人力成本。未经调整的ECMO患者出院率在洛杉矶为46%(46%),巴黎为56%,墨尔本为52%。我们发现,在洛杉矶一家医院,员工工资只解释了30%的较高人事成本。大部分成本差异是由人员配备强度和组合造成的。本研究展示了TDABC如何应用于ICU管理,以量化与法国和澳大利亚的医院相比,一家美国医院可以通过更少和更低成本的临床医生组合提供相同质量的护理。叙述性回顾将每个站点的护理模式演变的背景化,并帮助确定改变的潜在障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
It’s Not Just the Prices: Time-Driven Activity-Based Costing for Initiation of Veno-Venous Extracorporeal Membrane Oxygenation at Three International Sites—A Case Review
The United States spends more for intensive care units (ICUs) than do other high-income countries. We used time-driven activity-based costing (TDABC) to analyze ICU costs for initiation of veno-venous extracorporeal membrane oxygenation (VV ECMO) for respiratory failure to estimate how much of the higher ICU costs at 1 US site can be attributed to the higher prices paid to ICU personnel, and how much is caused by the US site’s use of a higher cost staffing model. We accompanied our TDABC approach with narrative review of the ECMO programs, at Cedars-Sinai (Los Angeles), Hôpital Pitié-Salpêtrière (Paris), and The Alfred Hospital (Melbourne) from 2017 to 2019. Our primary outcome was daily ECMO cost, and we hypothesized that cost differences among the hospitals could be explained by the efficiencies and skill mix of involved clinicians and prices paid for personnel, equipment, and consumables. Our results are presented relative to Los Angeles’ total personnel cost per VV ECMO patient day, indexed at 100. Los Angeles’ total indexed daily cost of care was 147 (personnel: 100, durables: 5, and disposables: 42). Paris’ total cost was 39 (26% of Los Angeles) (personnel: 12, durables: 1, and disposables: 26). Melbourne’s total cost was 53 (36% of Los Angeles) (personnel: 32, durables: 2, and disposables: 19) (rounded). The higher personnel prices at Los Angeles explained only 26% of its much higher personnel costs than Paris, and 21% relative to Melbourne. Los Angeles’ higher staffing levels accounted for 49% (36%), and its costlier mix of personnel accounted for 12% (10%) of its higher personnel costs relative to Paris (Melbourne). Unadjusted discharge rates for ECMO patients were 46% in Los Angeles (46%), 56% in Paris, and 52% in Melbourne. We found that personnel salaries explained only 30% of the higher personnel costs at 1 Los Angeles hospital. Most of the cost differential was caused by personnel staffing intensity and mix. This study demonstrates how TDABC may be used in ICU administration to quantify the savings that 1 US hospital could achieve by delivering the same quality of care with fewer and less-costly mix of clinicians compared to a French and Australian site. Narrative reviews contextualized how the care models evolved at each site and helped identify potential barriers to change.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
期刊最新文献
Novel Cancer Therapeutics: Perioperative Implications and Challenges. Xenon and Argon as Neuroprotective Treatments for Perinatal Hypoxic-Ischemic Brain Injury: A Preclinical Systematic Review and Meta-Analysis. Defining Postinduction Hemodynamic Instability With an Automated Classification Model. A Comparison of Remimazolam versus Propofol on Blood Pressure Changes During Therapeutic Endoscopic Retrograde Cholangiopancreatography: A Randomized Controlled Trial. Variations in Current Practice and Protocols of Intraoperative Multimodal Analgesia: A Cross-Sectional Study Within a Six-Hospital US Health Care System.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1