Resident Physician Thomas Jefferson University Philadelphia, Pennsylvania, United States
Introduction: Determining quality in healthcare requires the estimation of both cost and outcomes. We used time driven activity-based costing (TDABC) to determine the true cost of performing a one and two-level anterior cervical discectomy and fusion (ACDF) at our institution. Then, after collecting Neck Disability Index (NDI) and Visual Analogue Scale (VAS) data, we used the relation of the cost and outcomes to create a measure of value in the care delivered by ACDF.
Methods: TDABC was performed using a retrospective chart review and analysis of cost within the Operating Room Department. Paired t-test was used to compare NDI pre- and post-operatively. Linear regression analysis was performed to determine the relationship between cost and outcomes measures. A measure of value was created using change in NDI per $1,000 spent. This measure was used to determine differences in quality of care between three surgeons using an random effects one-way ANOVA test.
Results: The average cost of an ACDF during the allotted time period was $6,378. The average pre-operative and post-operative NDI scores were 19.6 ± 10.1 and 15.5 ± 11.5 (p=0.01), respectively. Average follow up was 12 weeks. Linear regression analysis determined no significant relationship was found between cost and change in NDI (p=0.18) or VAS (p=0.61). The average value index determined was 1.61 ± 1.66. ANOVA testing determined no significant difference between the three highest volume surgeons (p=0.56).
Conclusion : Our study did not reveal any significant relationship between cost of surgery and outcomes. The implication for this being that extra cost incurred does not relate to improved outcomes. Additionally, this is the first study to our knowledge relating TDABC to outcomes in spine surgery to directly measure value of care given.
How to Improve Patient Care: The goal of this analysis is to improve patient care through providing value. As national healthcare expenditures continue to increase, more focus will be placed not just on outcomes, but on value-based results. By completing this analysis for a common spine procedure, we are able to demonstrate a way to analyze value provided, and inquire into those factors which may allow a surgeon to provide more or less value to their patients.
