کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
5718517 | 1411252 | 2017 | 5 صفحه PDF | دانلود رایگان |
ObjectivesHealthcare reform policies are emphasizing value-based healthcare delivery. We hypothesize that time-driven activity-based costing (TDABC) can be used to appraise healthcare interventions in pediatric appendicitis.MethodsTriage-based standing delegation orders, surgical advanced practice providers, and a same-day discharge protocol were implemented to target deficiencies identified in our initial TDABC model. Post-intervention process maps for a hospital episode were created using electronic time stamp data for simple appendicitis cases during February to March 2016. Total personnel and consumable costs were determined using TDABC methodology.ResultsThe post-intervention TDABC model featured 6 phases of care, 33 processes, and 19 personnel types. Our interventions reduced duration and costs in the emergency department (â 41 min, â$23) and pre-operative floor (â 57 min, â$18). While post-anesthesia care unit duration and costs increased (+ 224 min, +$41), the same-day discharge protocol eliminated post-operative floor costs (â$306). Our model incorporating all three interventions reduced total direct costs by 11% ($2753.39 to $2447.68) and duration of hospitalization by 51% (1984 min to 966 min).ConclusionTime-driven activity-based costing can dynamically model changes in our healthcare delivery as a result of process improvement interventions. It is an effective tool to continuously assess the impact of these interventions on the value of appendicitis care.Level of evidenceII, Type of study: Economic Analysis.
Journal: Journal of Pediatric Surgery - Volume 52, Issue 6, June 2017, Pages 1045-1049