N. Shahzad1, U. F. Bhatti1, F. Mannan1, N. A. Pasha1, H. Zafar1 1Aga Khan University Medical College,Surgery,Karachi, Sindh, Pakistan
Introduction:
Porter et al. defined "value in healthcare" as health outcomes achieved per dollar spent and the concept revolves around the patient and not the provider. It is challenging to measure the value however as giving numeric value to health outcomes is novel concept. Objective of our study was to calculate and compare "value" delivered by individual surgeons for laparoscopic cholecystectomy.
Methods:
Data was collected for laparoscopic cholecystectomies performed over two years from Jan 01, 2016 till Dec 31, 2017. Only elective cholecystectomies performed for non-inflammed gall bladder were included in the analysis. Patients who had to be converted to open from laparoscopy were excluded as that increased the cost of care.
We devised formula for value calculation. Some operational definitions are as follows,
Minor post-operative issue: Stay more than 24 hours but less than 5 days, more than 1 clinic follow up visits within 30 days of operation.
Major post-operative Issues: Stay more than 5 days, emergency room visit or re-admission within 30 days of operation due to issues related to cholecystectomy
Numerator: Value of numerator was 100 if no major or minor issues encountered, 50 if some minor issue happened and 0 if any major issue happened.
Denominator: It was ratio of cost of individual cholecystectomy to the average cost of cholecystectomy performed in the study period
Value: Numerator / Denominator
Average value along with 95% and 99% confidence limits were calculated for the duration of study along with value provided by individual surgeons. Data has been plotted in funnel chart.
Results:
A total number of 1840 cholecystectomies were performed by nine surgeons in the study period out of which 1402 met the selection criteria. 817 went home within 24 hours of operation, while 16 patients stayed more than 5 days due to various reasons. 131 patients came to follow up clinic more than once after discharge from hospital. 62 patients had either emergency room visit or were re-admitted within 30 days of admission due to complications related to cholecystectomy. Mean +/- Standard Deviation of value provided was 83.95 +/- 43.07. Fig 1 shows funnel plot with 95% and 99% confidence limits along with values provided by individual surgeons. Value provided by surgeons “F” and “D” was greater than 99% upper confidence limit while value provided by surgeon “C” was below 99% lower confidence limit.
Conclusion:
Value provided by surgeons varies remarkably from one surgeon to another. Underlying factors need to be further explored to improve value.
Limitations:
Formula for value calculation needs to be validated.
Strengths:
First study to give numeric figure to concept of value
