Cheri Hunter

Implementation of a Value-Driven Outcomes Program to Identify High Variability in Clinical Costs and Outcomes and Association With Reduced Cost and Improved Quality

IMPORTANCE Transformation of US health care from volume to value requires meaningful quantification of costs and outcomes at the level of individual patients. OBJECTIVE To measure the association of a value-driven outcomes tool that allocates costs of care and quality measures to individual patient encounters with cost reduction and health outcome optimization. DESIGN, SETTING, AND PARTICIPANTS Uncontrolled, pre-post, longitudinal, observational study measuring quality and outcomes relative to cost from 2012 to 2016 at University of Utah Health Care. Clinical improvement projects included total hip and knee joint replacement, hospitalist laboratory utilization, and management of sepsis. EXPOSURES Physicians were given access to a tool with information about outcomes, costs (not charges), and variation and partnered with process improvement experts. MAIN OUTCOMES AND MEASURES Total and component inpatient and outpatient direct costs across departments; cost variability for Medicare severity diagnosis related groups measured as coefficient of variation (CV); and care costs and composite quality indexes. RESULTS From July 1, 2014, to June 30, 2015, there were 1.7 million total patient visits, including 34 000 inpatient discharges. Professional costs accounted for 24.3% of total costs for inpatient episodes (

Clinical value of amniotic fluid interleukin‐6 determinations in the management of preterm labour

114.4 million of

Amniotic fluid interleukin-10 (IL-10) concentrations during pregnancy and with labor

470.4 million) and 41.9% of total costs for outpatient visits (

Elevations of serum interleukin-12 concentrations in women with severe pre-eclampsia and HELLP syndrome

231.7 million of

Elevations of amniotic fluid macrophage inflammatory protein-1α concentrations in women during term and preterm labor

553.1 million). For Medicare severity diagnosis related groups with the highest total direct costs, cost variability was highest for postoperative infection (CV = 1.71) and sepsis (CV = 1.37) and among the lowest for organ transplantation (CV ≤ 0.43). For total joint replacement, a composite quality index was 54% at baseline (n = 233 encounters) and 80% 1 year into the implementation (n = 188 encounters) (absolute change, 26%; 95% CI, 18%-35%; P < .001). Compared with the baseline year, mean direct costs were 7% lower in the implementation year (95% CI, 3%-11%; P < .001) and 11% lower in the postimplementation year (95% CI, 7%-14%; P < .001). The hospitalist laboratory testing mean cost per day was

Value Driven Outcomes (VDO): a pragmatic, modular, and extensible software framework for understanding and improving health care costs and outcomes

138 (median [IQR],

Amniotic fluid epidermal growth factor levels in normal and abnormal pregnancies.

113 [

The intergenerational predisposition to operative delivery

79-160]; n = 2034 encounters) at baseline and

Validating prediction models of kidney transplant outcome using single center data

123 (median [IQR],

A population-based assessment of the familial component of acute kidney allograft rejection

99 [