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Abstract：
OBJECTIVE: The objective is to develop a pragmatic framework, based on value-based healthcare principles, to monitor health outcomes per unit costs on an institutional level. Subsequently, we investigated the association between health outcomes and healthcare utilisation costs.
METHODS: This is a retrospective cohort study.
METHODS: A teaching hospital in Rotterdam, The Netherlands.
METHODS: The study was performed in two use cases. The bariatric population contained 856 patients of which 639 were diagnosed with morbid obesity body mass index (BMI) <45 and 217 were diagnosed with morbid obesity BMI ≥45. The breast cancer population contained 663 patients of which 455 received a lumpectomy and 208 a mastectomy.
METHODS: The quality cost indicator (QCI) was the primary measures and was defined asQCI = (resulting outcome * 100)/average total costs (per thousand Euros)where average total costs entail all healthcare utilisation costs with regard to the treatment of the primary diagnosis and follow-up care. Resulting outcome is the number of patients achieving textbook outcome (passing all health outcome indicators) divided by the total number of patients included in the care path.
RESULTS: The breast cancer and bariatric population had the highest resulting outcome values in 2020 Q4, 0.93 and 0.73, respectively. The average total costs of the bariatric population remained stable (avg, €8833.55, min €8494.32, max €9164.26). The breast cancer population showed higher variance in costs (avg, €12 735.31 min €12 188.83, max €13 695.58). QCI values of both populations showed similar variance (0.3 and 0.8). Failing health outcome indicators was significantly related to higher hospital-based costs of care in both populations (p <0.01).
CONCLUSIONS: The QCI framework is effective for monitoring changes in average total costs and relevant health outcomes on an institutional level. Health outcomes are associated with hospital-based costs of care.
METHODS: This is a retrospective cohort study.
METHODS: A teaching hospital in Rotterdam, The Netherlands.
METHODS: The study was performed in two use cases. The bariatric population contained 856 patients of which 639 were diagnosed with morbid obesity body mass index (BMI) <45 and 217 were diagnosed with morbid obesity BMI ≥45. The breast cancer population contained 663 patients of which 455 received a lumpectomy and 208 a mastectomy.
METHODS: The quality cost indicator (QCI) was the primary measures and was defined asQCI = (resulting outcome * 100)/average total costs (per thousand Euros)where average total costs entail all healthcare utilisation costs with regard to the treatment of the primary diagnosis and follow-up care. Resulting outcome is the number of patients achieving textbook outcome (passing all health outcome indicators) divided by the total number of patients included in the care path.
RESULTS: The breast cancer and bariatric population had the highest resulting outcome values in 2020 Q4, 0.93 and 0.73, respectively. The average total costs of the bariatric population remained stable (avg, €8833.55, min €8494.32, max €9164.26). The breast cancer population showed higher variance in costs (avg, €12 735.31 min €12 188.83, max €13 695.58). QCI values of both populations showed similar variance (0.3 and 0.8). Failing health outcome indicators was significantly related to higher hospital-based costs of care in both populations (p <0.01).
CONCLUSIONS: The QCI framework is effective for monitoring changes in average total costs and relevant health outcomes on an institutional level. Health outcomes are associated with hospital-based costs of care.
摘要：
目标：目标是开发一个务实的框架，基于基于价值的医疗保健原则，在机构层面监测单位成本的健康结果。随后，我们调查了健康结局与医疗保健利用成本之间的关联.
方法：这是一项回顾性队列研究。
方法：鹿特丹的教学医院，荷兰。
方法：该研究在两个用例中进行。减肥人群包含856例患者，其中639例被诊断为病态肥胖体重指数（BMI）<45，217例被诊断为病态肥胖BMI≥45。乳腺癌人群包括663名患者，其中455名接受了乳房肿瘤切除术，208名接受了乳房切除术。
方法：质量成本指标（QCI）是主要衡量标准，其定义为QCI=（结果结果*100）/平均总成本（每千欧元），其中平均总成本涉及与主要诊断和后续护理治疗有关的所有医疗保健利用成本。结果是获得教科书结果（通过所有健康结果指标）的患者人数除以护理路径中包含的患者总数。
结果：乳腺癌和肥胖症患者在2020年第四季度的结果值最高，分别为0.93和0.73。肥胖人群的平均总成本保持稳定(平均值，8833.55欧元，最低8494.32欧元，最高9164.26欧元）。乳腺癌人群显示出更高的成本差异(平均值，€12735.31分€12188.83，最高€13695.58）。两个群体的QCI值显示相似的方差(0.3和0.8)。健康结果指标的失败与两个人群中基于医院的护理费用的增加显着相关（p<0.01）。
结论：QCI框架对于在机构层面监测平均总成本和相关健康结果的变化是有效的。健康结果与基于医院的护理成本相关。
方法：这是一项回顾性队列研究。
方法：鹿特丹的教学医院，荷兰。
方法：该研究在两个用例中进行。减肥人群包含856例患者，其中639例被诊断为病态肥胖体重指数（BMI）<45，217例被诊断为病态肥胖BMI≥45。乳腺癌人群包括663名患者，其中455名接受了乳房肿瘤切除术，208名接受了乳房切除术。
方法：质量成本指标（QCI）是主要衡量标准，其定义为QCI=（结果结果*100）/平均总成本（每千欧元），其中平均总成本涉及与主要诊断和后续护理治疗有关的所有医疗保健利用成本。结果是获得教科书结果（通过所有健康结果指标）的患者人数除以护理路径中包含的患者总数。
结果：乳腺癌和肥胖症患者在2020年第四季度的结果值最高，分别为0.93和0.73。肥胖人群的平均总成本保持稳定(平均值，8833.55欧元，最低8494.32欧元，最高9164.26欧元）。乳腺癌人群显示出更高的成本差异(平均值，€12735.31分€12188.83，最高€13695.58）。两个群体的QCI值显示相似的方差(0.3和0.8)。健康结果指标的失败与两个人群中基于医院的护理费用的增加显着相关（p<0.01）。
结论：QCI框架对于在机构层面监测平均总成本和相关健康结果的变化是有效的。健康结果与基于医院的护理成本相关。
