Theodore Stefos

Excess Costs Attributable to Postoperative Complications

This article estimates excess costs associated with postoperative complications among inpatients treated in Veterans Health Administration (VA) hospitals. The authors conducted an observational study on 43,822 hospitalizations involving inpatient surgery in one of 104 VA hospitals during fiscal year 2007. Hospitalization-level cost regression analyses were performed to estimate the excess cost of each of 18 unique postoperative complications. The authors used generalized linear modeling techniques to account for the heavily skewed cost distribution. Costs were measured using an activity-based cost accounting system and complications were assessed based on medical chart review conducted by the VA ‘National Surgical Quality Improvement Program. The authors found excess costs associated with postoperative complications ranging from

Measuring the cost of hospital adverse patient safety events.

8,338 for “superficial surgical site infection” to

Controlling for quality in the hospital cost function

29,595 for “failure to wean within 24 hours in the presence of respiratory complications.” The results obtained suggest that quality improvement efforts aimed at reducing postoperative complications can contribute significantly to lowering of hospital costs.

The effect of physician panel size on health care outcomes.

This paper estimates the excess cost of hospital inpatient care due to adverse safety events in the U.S. Department of Veterans Affairs (VA) hospitals during fiscal year 2007. We measured adverse events according to the Patient Safety Indicator (PSI) algorithms of the Agency for Healthcare Research and Quality. Patient level cost regression analyses were performed using generalized linear modeling techniques. Accounting for the heavily skewed distribution of costs among patients having adverse safety events, results suggested that the excess cost of nine different PSIs for VA patients are much higher than previously estimated. We tested sensitivity of results to whether costs were measured by VAs Decision Support System (DSS) that uses local costs of specific inputs, or by the average costing system developed by VAs Health Economics Resource Center. DSS costing appeared to better characterize the high cost patients.

The cost of hospital readmissions: evidence from the VA

This paper explores the relationship between the cost and quality of hospital care from the perspective of applied microeconomics. It addresses both theoretical and practical complexities entailed in incorporating hospital quality into the estimation of hospital cost functions. That literature is extended with an empirical analysis that examines the use of 15 Patient Safety Indicators (PSIs) as measures of hospital quality. A total operating cost function is estimated on 2,848 observations from five states drawn from the period 2001 to 2007. In general, findings indicate that the PSIs are successful in capturing variation in hospital cost due to adverse patient safety events. Measures that rely on the aggregate number of adverse events summed over PSIs are found to be superior to risk-adjusted rates for individual PSIs. The marginal cost of an adverse event is estimated to be

Federal provision of health care: creating access for the underinsured.

22,413. The results contribute to a growing business case for inpatient safety in hospital services.

Data and information requirements for the Department of Veterans Affairs resource allocation systems.

An inadequate supply of primary care providers is leading to a crisis in access. Pressures are being placed on primary care practices to increase panel sizes. The impact of these pressures on clinical processes, patient satisfaction and waiting times is largely unknown, although evidence from recent literature shows that longer waiting time results in higher mortality rates and other adverse outcomes. FY2004, Department of Veterans Affairs primary care patient data are used. GLIMMIX and other generalized linear model models illustrate how expanded panel sizes are correlated with clinical process indicators, patient satisfaction and waiting times, controlling for practice, provider and patient characteristics. We generally find that larger panel sizes are related to statistically significant increases in waiting time. However, larger panel sizes appear to have generally small effects on patient process indicators and satisfaction. Panels with more support staff have lower waiting times and small, improved outcomes. We find panels with older and clinically riskier patients have, on average, slightly lower waiting times and increased likelihoods of positive outcomes than panels with younger, healthier veterans. Female veterans appear to have reduced likelihoods of positive outcomes. Higher priority and female veterans also have lower satisfaction. Further study is needed to analyse the impact of potential panel size endogeneity in this system.

Dynamics of the mental health workforce: investigating the composition of physicians and other health providers

This paper is an examination of hospital 30-day readmission costs using data from 119 acute care hospitals operated by the U.S. Veterans Administration (VA) in fiscal year 2011. We applied a two-part model that linked readmission probability to readmission cost to obtain patient level estimates of expected readmission cost for VA patients overall, and for patients discharged for three prevalent conditions with relatively high readmission rates. Our focus was on the variable component of direct patient cost. Overall, managers could expect to save

Determining population based mortality risk in the Department of Veterans Affairs

2140 for the average 30-day readmission avoided. For heart attack, heart failure, and pneumonia patients, expected readmission cost estimates were

Relational climate and health care costs: Evidence From diabetes care

3432,