Process of Care Events in Transplantation: Effects on the Cost of Hospitalization

Deviations in the processes of healthcare delivery that affect patient outcomes are recognized to have an impact on the cost of hospitalization. Whether deviations that do not affect patient outcome affects cost has not been studied. We have analyzed process of care (POC) events that were reported i...

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Bibliographic Details
Published in:	American journal of transplantation 2010-10, Vol.10 (10), p.2341-2348
Main Authors:	Egorova, N. N., Gelijns, A. C., Moskowitz, A. J., Emond, J. C., Krapf, R., Lazar, E. J., Guillerme, S., Kaplan, H. S., Greco, G.
Format:	Article
Language:	eng
Subjects:	Adolescent Adult Biological and medical sciences Child Costs Costs and Cost Analysis - economics Delivery of Health Care - economics Female hospitalization Hospitalization - economics Humans Length of Stay - economics Male Medical sciences Middle Aged Miscellaneous Organ Transplantation - economics Public health. Hygiene Public health. Hygiene-occupational medicine quality of care Severity of Illness Index Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
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Summary:	Deviations in the processes of healthcare delivery that affect patient outcomes are recognized to have an impact on the cost of hospitalization. Whether deviations that do not affect patient outcome affects cost has not been studied. We have analyzed process of care (POC) events that were reported in a large transplantation service (n = 3,012) in 2005, delineating whether or not there was a health consequence of the event and assessing the impact on hospital resource utilization. Propensity score matching was used to adjust for patient differences. The rate of POC events varied by transplanted organ: from 10.8 per 1000 patient days (kidney) to 17.3 (liver). The probability of a POC event increased with severity of illness. The majority (81.5%) of the POC events had no apparent effect on patients’ health (63.6% no effect and 17.9% unknown). POC events were associated with longer length of stay (LOS) and higher costs independent of whether there was a patient health impact. Multiple events during the same hospitalization were associated with the highest impact on LOS and cost. POC events in transplantation occur frequently, more often in sicker patients and, although the majority of POC events do not harm the patient, their effect on resource utilization is significant. Process of care events are a significant component of the cost of health care in transplantation, even though the majority does not harm patients.
ISSN:	1600-6135 1600-6143