Highly variable and complex care - Home - KAGB · Highly variable and complex care Johan C. Kips,...
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Highly variable and complex care
Johan C. Kips, MD, PhD
CEO CUB-Erasme
ARMB-KAGB, 7 october 2017
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HIGHLY VARIABLE AND COMPLEX CARE
Definition
Outcome of hospital care
Role of AMC
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VARIABILITY OF CARE
APR-DRG 228 :
Inguinal, femoral & Umbilical
Hernia Procedures
Qcod = coefficient of
quartile dispersion
(Q3-Q1)/(Q3+Q1)
Inter- and intra-hospital variabilty
Devriese ea, KCE report 2016
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VARIABILITY OF CARE
Cardiac valve
procedures PCI
Towards lump sum financing for low variability care ?
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COMPLEXITY OF CARE
Variable definitions in literature :
Patients undergoing highly complex interventions
eg pancreatic, esophageal or thoracic oncological surgery
versus
Complex care patients :
eg elderly patient with multiple chronic conditions and dementia
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HIGHLY VARIABLE AND COMPLEX CARE
Definition
Outcome of hospital care
Role of AMC
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ASSOCIATION BETWEEN TEACHING STATUS AND
MORTALITY IN US HOSPITALS
30-d mortality (%) Major teaching Minor teaching Nonteaching P value
All hospitalisations 8.3 9.2 9.5 < 0.001
Medical conditions 11.0 11.6 11.9 < 0.001
Surgical procedures 3.3 3.8 4.0 < 0.001
Burke ea, JAMA 2017;317:2105-2113
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BEYOND VOLUME : DOES HOSPITAL COMPLEXITY
MATTER ?
McCrum ea, Medical Care 2014; 52: 235-242
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BEYOND VOLUME : DOES HOSPITAL COMPLEXITY
MATTER ?
Effect of increasing hospital complexity on mortality rates
at low- and high-volume hospitals
McCrum ea, Medical Care 2014; 52: 235-242
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COMPARISON OF HOSPITAL MORTALITY AND
READMISSION RATES FOR MEDICARE PATIENTS
TREATED BY MALE VS FEMALE PFYSICIANS
Tsugawa ea, JAMA Intern Med 2017; 177: 206-213
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OUTCOME OF HOSPITAL CARE
Major determinants ?
Multidisciplinary approach
Importance of physician contracts (salary-based) ?
Degree of surgical team (sub-)specialisation
Implementation of innovations
Adherence to EBM / scientific guidelines
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HIGHLY VARIABLE AND COMPLEX CARE
Definition
Outcome of hospital care
Role of AMC
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ROLE OF AMC IN HEALTH CARE ORGANISATION
To fulfill requirements for high-quality in-hospital care for
complex patients
Importance of scale
=> Central position in « hub and spoke » hospital landscape
To fulfill requirements for a high-quality approach to
complex care patients
Leading role in development of integrated patient centered care
models for chronic conditions