Outcomes of the shift in care from inpatient to outpatient procedures in hysterectomy
This presentation is the property of its rightful owner.
Sponsored Links
1 / 33

Outcomes of the Shift in Care from Inpatient to Outpatient Procedures in Hysterectomy PowerPoint PPT Presentation


  • 135 Views
  • Uploaded on
  • Presentation posted in: General

Outcomes of the Shift in Care from Inpatient to Outpatient Procedures in Hysterectomy. Stephanie Makepeace. Background. Hysterectomy. Removal of the uterus 641,000 procedures a year Most common major surgery in women ages 18 to 44, after cesarean section.

Download Presentation

Outcomes of the Shift in Care from Inpatient to Outpatient Procedures in Hysterectomy

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Outcomes of the shift in care from inpatient to outpatient procedures in hysterectomy

Outcomes of the Shift in Care from Inpatient to Outpatient Procedures in Hysterectomy

Stephanie Makepeace


Background

Background


Hysterectomy

Hysterectomy

  • Removal of the uterus

  • 641,000 procedures a year

  • Most common major surgery in women ages 18 to 44, after cesarean section

Merrill RM et al. Med SciMonit. 2008; National Center for Health Statistics. 2006


Hysterectomy type

Hysterectomy Type

Photo Source: http://en.wikipedia.org/wiki/Hysterectomy


Surgical approach

Surgical Approach

Laparoscopic

Traditional Open

Vaginal

Laparoscopic- Assisted Vaginal

Photo Source: http://www.cincyobgyn.com/services-hysterectomy-obgyn-fairfield-ohio.html


Healthcare costs

Healthcare Costs

  • US spends 2.8 trillion dollars a year

  • 17.9% of the gross domestic product

Centers for Medicare and Medicaid Services. National Health Expenditures. 2013

World Bank. Health Expenditure. 2011


Cost reduction

Cost Reduction

  • Disease Prevention

  • Increase healthcare delivery efficiency

  • Value-based decision-making

    • Minimally Invasive Procedures

      • Smaller incisions may reduce the chance of infection and shorten hospital stay

    • Healthcare Setting

Inpatient Setting

Outpatient Setting


Overall project objectives

Overall Project Objectives

  • Identify trends in hysterectomy surgical approach and surgical setting

  • Estimate difference in hysterectomy cost between inpatient and outpatient setting using real world data

  • Present hysterectomy data in interactive tool


Project summary

Project Summary


Methods

Methods

  • Retrospective Review of Premier Hospital Database from 2009 to 2012

    • Database houses billing/coding for 45 million inpatient and 210 million outpatient visits

    • Accounts for ~20% of all US hospital discharges

  • Identified applicable hysterectomy, infection, and cancer codes

    • International Classification of Diseases, 9th edition (ICD-9) and current procedural terminology (CPT) codes

  • Study was approved by the University of Florida IRB


Data analysis

Data Analysis

  • Tableau Desktop version 1.8

    • Prepare visualizations and descriptive statistics

  • SPSS version 22

    • Multivariate analyses by ordinary least squares regression


Results

Results


Number of hysterectomies 2009 2012

Number of Hysterectomies (2009-2012)


Hysterectomy type over time

Hysterectomy Type Over Time

Stacked bar chart; Hysterectomies 2009 to 2012


Payer type

Payer Type

Inpatient

Outpatient


Unadjusted patient cost all hysterectomies

Unadjusted Patient Cost All Hysterectomies

Overall median unadjusted patient cost: $6,610

Min: $1

Max:$2,691,805

Graph excludes patient costs >$40,000


Unadjusted median cost by surgical approach

Unadjusted Median Cost by Surgical Approach

Overall

Inpatient

Outpatient


Unadjusted median cost by hysterectomy type and cancer incidence

Unadjusted Median Cost by Hysterectomy Type and Cancer Incidence

No Cancer

Cancer of Uterus/Cervix

Inpatient

Outpatient

Inpatient

Outpatient


Unadjusted median cost by payer group impact of patient age

Unadjusted Median Cost by Payer Group--Impact of Patient Age--

  • Age was also higher in patients with cancer (61 years) compared to those without (45 years)


Unadjusted cost over time

Unadjusted Cost Over Time


Unadjusted median cost by us region

Unadjusted Median Cost by US Region

Highest Costs

$8,070

$7,665

$6,268

$6,376

$7,543

$6,368

$6,437

$5,049

$6,271

Lowest Costs

*Pacific Region includes Alaska and Hawaii, not shown


Multivariable regression

Multivariable Regression

  • Difference in Patient Cost Accounting for:

    • Procedure Setting

      • Inpatient/Outpatient

    • Hysterectomy Type

      • Total, Subtotal, Radical

    • Surgical Approach

      • Open, Vaginal, Laparoscopic

    • Cancer Incidence

      • Yes/No

    • Age

    • Race

      • White, Black, Asian, American Indian

    • Payer

      • Commercial, Medicaid, Medicare


Adjusted patient cost

Adjusted Patient Cost

-23%

Outpatient

Inpatient

(95% CI= 23% to 24%)

-19%

+11%

Vaginal

Traditional

Laparoscopic

(95% CI= 19% to 20%)

(95% CI= 10% to 11%)


Length of stay

Length of Stay


Infection

Infection


Tableau dashboard

Tableau Dashboard


Summary discussion

Summary/Discussion


Summary

Summary

  • Outpatient Setting

    • More hysterectomy procedures are being conducted in the outpatient setting

    • Lower patient cost

    • Benefits to infection incidence and length of stay

  • Minimally Invasive Techniques

    • In hysterectomies, the use of minimally invasive techniques is on the rise within the outpatient setting

    • Laparoscopic hysterectomies report a higher patient cost compared to open or vaginal procedures


Limitations

Limitations

  • Factors not taken into account

    • Operating room time

    • Physician Experience/ Learning Curve

    • Patient recovery

      • Return to Activity

      • Return to Work

      • Cosmetics/ Appearance

  • Selection bias

    • Greater percent (67%) cancer patients treated inpatient

    • Inpatient had comorbidity index, outpatient did not

  • Infection incidence is difficult to track, as patients may return to primary care physician for care

  • ICD-9 and CPT codes not reviewed by expert


Implications

Implications

  • Real world data confirms increasing use of outpatient hysterectomies and its potential cost benefit

  • Future Use of Tableau

    • Provided to patients to facilitate cost procedure cost transparency

    • Help identify epidemiological trends or disease outbreaks

    • Education tools


Public health practice concentration competencies

Public Health Practice Concentration Competencies

  • Identify & understand the historical context of epidemiology, epidemiologic terminology, study designs & methodology

  • Demonstrate ability to analyze & interpret epidemiologic data

  • Explain & communicate current epidemiologic & public health problems for informing scientific, ethical, economic & political discussions of health problems

  • Demonstrate communication skills key to public health workforce participation and advocacy

  • Identify, retrieve, summarize, manage and communicate public health information


Questions

Questions?


  • Login