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Standardising practice in cardiology: reducing clinical variation and cost at Ochsner Health System

dc.contributor.authorPhil Oravetz
dc.contributor.authorChristopher J White
dc.contributor.authorDavid Carmouche
dc.contributor.authorNicole Swan
dc.contributor.authorJosh Donaldson
dc.contributor.authorRussel Ruhl
dc.contributor.authorCzarlota Valdenor
dc.contributor.authorDavid Paculdo
dc.contributor.authorMary Tran
dc.contributor.authorJohn Peabody
dc.contributor.otherOchsner Health System, New Orleans, Louisiana, USA
dc.contributor.otherOchsner Health System, New Orleans, Louisiana, USA
dc.contributor.otherOchsner Health System, New Orleans, Louisiana, USA
dc.contributor.otherOchsner Health System, New Orleans, Louisiana, USA
dc.contributor.otherOchsner Health System, New Orleans, Louisiana, USA
dc.contributor.otherOchsner Health System, New Orleans, Louisiana, USA
dc.contributor.otherQURE Healthcare, San Francisco, California, USA
dc.contributor.other1 QURE Healthcare, San Francisco, California, USA
dc.contributor.otherQURE Healthcare, San Francisco, California, USA
dc.contributor.other1 QURE Healthcare, San Francisco, California, USA
dc.date.accessioned2025-10-09T05:15:52Z
dc.date.available2025-10-09T05:15:52Z
dc.date.issued01-May-2019
dc.identifier.urihttps://openheart.bmj.com/content/6/1/e000994.full
dc.identifier.urihttp://digilib.fisipol.ugm.ac.id/repo/handle/15717717/40892
dc.description.abstractObjective Low quality and unwarranted clinical variation harm patients and increase unnecessary costs. Effective approaches to improve clinical and economic value have been difficult. The Ochsner Health System looked to improve clinical care quality and reduce unnecessary costs in cardiology using active measurement and customised feedback.Methods We serially measured care decisions using online, simulated cases to capture clinical details of cardiology practice and provide individual feedback. Fifty cardiologists cared for two simulated patients in each of six assessment rounds occurring 4 months apart. Simulated patients presented with heart failure (HF), coronary artery disease (CAD), supraventricular tachyarrhythmia (SVT) or valvular heart disease. Using Ochsner’s patient-level data, we performed real-world pre–post analyses of physician practice changes, patient outcomes and costs.Results Between baseline and final rounds, overall simulated quality-of-care scores improved 14.1% (p<0.001). In the same period, we found cost-of-care variation decreased in patient-level data, with larger decreases for more severely ill patients. The total per-patient direct costs decreased $493 in SVT, $305 in HF and $55 in CAD (p<0.05 for SVT and HF). Readmission rates fell significantly for HF (from 20.0% to 11.9%) and SVT (from 14.5% to 7.8%) (both p<0.001) and non-significantly for CAD (from 13.7% to 11.3%, p=0.112). The cost avoidance/revenue generation opportunity from reduced readmissions and direct costs amounted to annual savings of $4.34 million, with no significant changes to in-hospital mortality rates (p>0.05).Conclusions Using simulated patients to serially measure and provide individual feedback on clinical practice significantly raises quality and reduces practice variation and costs without negatively impacting outcomes.
dc.language.isoEN
dc.publisherBMJ Publishing Group
dc.subject.lccDiseases of the circulatory (Cardiovascular) system
dc.titleStandardising practice in cardiology: reducing clinical variation and cost at Ochsner Health System
dc.typeArticle
dc.description.doi10.1136/openhrt-2018-000994
dc.title.journalOpen Heart
dc.identifier.e-issn2053-3624
dc.identifier.oaioai:doaj.org/journal:95753c2514e1409b9708b19ccb0a0896
dc.journal.infoVolume 6, Issue 1


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