Using value-based analysis to influence outcomes in complex surgical systems

Journal of the American College of Surgeons
John R KirkpatrickJohn L Zapas

Abstract

Value-based analysis (VBA) is a management strategy used to determine changes in value (quality/cost) when a usual practice (UP) is replaced by a best practice (BP). Previously validated in clinical initiatives, its usefulness in complex systems is unknown. To answer this question, we used VBA to correct deficiencies in cardiac surgery at Memorial Healthcare System. Cardiac surgery is a complex surgical system that lends itself to VBA because outcomes metrics provided by the Society of Thoracic Surgeons provide an estimate of quality; cost is available from Centers for Medicare and Medicaid Services and other contemporary sources; the UP can be determined; and the best practice can be established. Analysis of the UP at Memorial Healthcare System revealed considerable deficiencies in selection of patients for surgery; the surgery itself, including choice of procedure and outcomes; after care; follow-up; and control of expenditures. To correct these deficiencies, each UP was replaced with a BP. Changes included replacement of most of the cardiac surgeons; conversion to an employed physician model; restructuring of a heart surgery unit; recruitment of cardiac anesthesiologists; introduction of an interactive educational program; e...Continue Reading

References

Mar 7, 2000·JAMA : the Journal of the American Medical Association·R A DudleyA Milstein
Apr 12, 2002·The New England Journal of Medicine·John D BirkmeyerDavid E Wennberg
Jun 27, 2008·Medical Care·Vivian Ho, Thomas Aloia
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Jun 3, 2011·The New England Journal of Medicine·Jonathan F FinksJohn D Birkmeyer
Nov 1, 2014·Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research·M C Tang

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Citations

Nov 3, 2015·The Annals of Otology, Rhinology, and Laryngology·Christopher R JacksonDavid O Francis
Jul 1, 2021·Journal of Healthcare Management / American College of Healthcare Executives·Bruna Stella ZanottoCarisi Anne Polanczyk
Sep 26, 2017·Journal of Vascular Surgery·Thomas C Bower

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