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Cost-effectiveness of an Emergency Department–Based Intensive Care Unit
IMPORTANCE: Value in health care is quality per unit cost (V = Q/C), and an emergency department–based intensive care unit (ED-ICU) model has been associated with improved quality. To assess the value of this care delivery model, it is essential to determine the incremental direct cost of care. OBJE...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9520346/ https://www.ncbi.nlm.nih.gov/pubmed/36169958 http://dx.doi.org/10.1001/jamanetworkopen.2022.33649 |
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author | Bassin, Benjamin S. Haas, Nathan L. Sefa, Nana Medlin, Richard Peterson, Timothy A. Gunnerson, Kyle Maxwell, Steve Cranford, James A. Laurinec, Stephanie Olis, Christine Havey, Renee Loof, Robert Dunn, Patrick Burrum, Debra Gegenheimer-Holmes, Jennifer Neumar, Robert W. |
author_facet | Bassin, Benjamin S. Haas, Nathan L. Sefa, Nana Medlin, Richard Peterson, Timothy A. Gunnerson, Kyle Maxwell, Steve Cranford, James A. Laurinec, Stephanie Olis, Christine Havey, Renee Loof, Robert Dunn, Patrick Burrum, Debra Gegenheimer-Holmes, Jennifer Neumar, Robert W. |
author_sort | Bassin, Benjamin S. |
collection | PubMed |
description | IMPORTANCE: Value in health care is quality per unit cost (V = Q/C), and an emergency department–based intensive care unit (ED-ICU) model has been associated with improved quality. To assess the value of this care delivery model, it is essential to determine the incremental direct cost of care. OBJECTIVE: To determine the association of an ED-ICU with inflation-adjusted change in mean direct cost of care, net revenue, and direct margin per ED patient encounter. DESIGN, SETTING, AND PARTICIPANTS: This retrospective economic analysis evaluated the cost of care delivery to patients in the ED before and after deployment of the Joyce and Don Massey Family Foundation Emergency Critical Care Center, an ED-ICU, on February 16, 2015, at a large academic medical center in the US with approximately 75 000 adult ED visits per year. The pre–ED-ICU cohort was defined as all documented ED visits by patients 18 years or older with a complete financial record from September 8, 2012, through June 30, 2014 (660 days); the post–ED-ICU cohort, all visits from July 1, 2015, through April 21, 2017 (660 days). Fiscal year 2015 was excluded from analysis to phase in the new care model. Statistical analysis was performed March 1 through December 30, 2021. EXPOSURES: Implementation of an ED-ICU. MAIN OUTCOMES AND MEASURES: Inflation-adjusted direct cost of care, net revenue, and direct margin per patient encounter in the ED. RESULTS: A total of 234 884 ED visits during the study period were analyzed, with 115 052 patients (54.7% women) in the pre–ED-ICU cohort and 119 832 patients (54.5% women) in the post–ED-ICU cohort. The post–ED-ICU cohort was older (mean [SD] age, 49.1 [19.9] vs 47.8 [19.6] years; P < .001), required more intensive respiratory support (2.2% vs 1.1%; P < .001) and more vasopressor use (0.5% vs 0.2%; P < .001), and had a higher overall case mix index (mean [SD], 1.7 [2.0] vs 1.5 [1.7]; P < .001). Implementation of the ED-ICU was associated with similar inflation-adjusted total direct cost per ED encounter (pre–ED-ICU, mean [SD], $4875 [$15 175]; post–ED-ICU, $4877 [$17 400]; P = .98). Inflation-adjusted net revenue per encounter increased by 7.0% (95% CI, 3.4%-10.6%; P < .001), and inflation-adjusted direct margin per encounter increased by 46.6% (95% CI, 32.1%-61.2%; P < .001). CONCLUSIONS AND RELEVANCE: Implementation of an ED-ICU was associated with no significant change in inflation-adjusted total direct cost per ED encounter. Holding delivery costs constant while improving quality demonstrates improved value via the ED-ICU model of care. |
format | Online Article Text |
id | pubmed-9520346 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-95203462022-10-18 Cost-effectiveness of an Emergency Department–Based Intensive Care Unit Bassin, Benjamin S. Haas, Nathan L. Sefa, Nana Medlin, Richard Peterson, Timothy A. Gunnerson, Kyle Maxwell, Steve Cranford, James A. Laurinec, Stephanie Olis, Christine Havey, Renee Loof, Robert Dunn, Patrick Burrum, Debra Gegenheimer-Holmes, Jennifer Neumar, Robert W. JAMA Netw Open Original Investigation IMPORTANCE: Value in health care is quality per unit cost (V = Q/C), and an emergency department–based intensive care unit (ED-ICU) model has been associated with improved quality. To assess the value of this care delivery model, it is essential to determine the incremental direct cost of care. OBJECTIVE: To determine the association of an ED-ICU with inflation-adjusted change in mean direct cost of care, net revenue, and direct margin per ED patient encounter. DESIGN, SETTING, AND PARTICIPANTS: This retrospective economic analysis evaluated the cost of care delivery to patients in the ED before and after deployment of the Joyce and Don Massey Family Foundation Emergency Critical Care Center, an ED-ICU, on February 16, 2015, at a large academic medical center in the US with approximately 75 000 adult ED visits per year. The pre–ED-ICU cohort was defined as all documented ED visits by patients 18 years or older with a complete financial record from September 8, 2012, through June 30, 2014 (660 days); the post–ED-ICU cohort, all visits from July 1, 2015, through April 21, 2017 (660 days). Fiscal year 2015 was excluded from analysis to phase in the new care model. Statistical analysis was performed March 1 through December 30, 2021. EXPOSURES: Implementation of an ED-ICU. MAIN OUTCOMES AND MEASURES: Inflation-adjusted direct cost of care, net revenue, and direct margin per patient encounter in the ED. RESULTS: A total of 234 884 ED visits during the study period were analyzed, with 115 052 patients (54.7% women) in the pre–ED-ICU cohort and 119 832 patients (54.5% women) in the post–ED-ICU cohort. The post–ED-ICU cohort was older (mean [SD] age, 49.1 [19.9] vs 47.8 [19.6] years; P < .001), required more intensive respiratory support (2.2% vs 1.1%; P < .001) and more vasopressor use (0.5% vs 0.2%; P < .001), and had a higher overall case mix index (mean [SD], 1.7 [2.0] vs 1.5 [1.7]; P < .001). Implementation of the ED-ICU was associated with similar inflation-adjusted total direct cost per ED encounter (pre–ED-ICU, mean [SD], $4875 [$15 175]; post–ED-ICU, $4877 [$17 400]; P = .98). Inflation-adjusted net revenue per encounter increased by 7.0% (95% CI, 3.4%-10.6%; P < .001), and inflation-adjusted direct margin per encounter increased by 46.6% (95% CI, 32.1%-61.2%; P < .001). CONCLUSIONS AND RELEVANCE: Implementation of an ED-ICU was associated with no significant change in inflation-adjusted total direct cost per ED encounter. Holding delivery costs constant while improving quality demonstrates improved value via the ED-ICU model of care. American Medical Association 2022-09-28 /pmc/articles/PMC9520346/ /pubmed/36169958 http://dx.doi.org/10.1001/jamanetworkopen.2022.33649 Text en Copyright 2022 Bassin BS et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Bassin, Benjamin S. Haas, Nathan L. Sefa, Nana Medlin, Richard Peterson, Timothy A. Gunnerson, Kyle Maxwell, Steve Cranford, James A. Laurinec, Stephanie Olis, Christine Havey, Renee Loof, Robert Dunn, Patrick Burrum, Debra Gegenheimer-Holmes, Jennifer Neumar, Robert W. Cost-effectiveness of an Emergency Department–Based Intensive Care Unit |
title | Cost-effectiveness of an Emergency Department–Based Intensive Care Unit |
title_full | Cost-effectiveness of an Emergency Department–Based Intensive Care Unit |
title_fullStr | Cost-effectiveness of an Emergency Department–Based Intensive Care Unit |
title_full_unstemmed | Cost-effectiveness of an Emergency Department–Based Intensive Care Unit |
title_short | Cost-effectiveness of an Emergency Department–Based Intensive Care Unit |
title_sort | cost-effectiveness of an emergency department–based intensive care unit |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9520346/ https://www.ncbi.nlm.nih.gov/pubmed/36169958 http://dx.doi.org/10.1001/jamanetworkopen.2022.33649 |
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