ITERATIVE MODELING AND EVALUATION OF THE CLINICAL AND ECONOMIC OUTCOMES OF PAC

PAC 临床和经济结果的迭代建模和评估

• 批准号: 6102654
• 负责人: CURTIS P LANGLOTZ
• 金额: $ 21.3万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-01-01 至 1999-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6102654
• 关键词: clinical research; computer system design /evaluation; health care cost /financing; health care facility information system; human data; mathematical model; model design /development; radiology

The aims of this project are to measure, estimate, and model the effect of a series of specific interventions involving the implementation of a Picture Archiving and Communication System (PACS) on the health outcomes of patients and on the finances of a radiology practice, clinical unit, and medical center. The three principal components of our approach are (1) develop a financial model from estimated and actual expenses before and after each intervention, (2) derive multivariate models that estimate the independent effects of PACS interventions on health outcome surrogates, and (3) construct a cost effectiveness model that integrates incremental costs and health outcomes associated with each intervention in a single metric. First, we will estimate the cost of equipment, supplies, and personnel from actual expense information (prior to PACS interventions), and from actual and projected needs of the radiology department (after PACS interventions). These data will be used to develop an incremental direct-cost model of PACS from the perspective of a health system. Next, we will measure readily available surrogate variables that are likely to correlate highly with the health outcomes of patients: the rate of inpatient admission, the length of inpatient stay (for admitted patients), the need for and cost of subsequent health care. Multivariate analysis will be used to detect whether the outcome surrogates are influenced by the interventions, and by other factors known to influence these variables (e.g., case mix). Our hypothesis is that, after controlling for the underlying clinical and demographic differences among patients, patients imaged after a PACS intervention compared to those imaged before the intervention, will have shorter lengths of stay, shorter ED visits, shorter exam performance times, and decreased costs of care. Finally, cost-effectiveness metrics will be computed as cost per diagnostic value, cost per increment of process improvement, and as cost per health outcome surrogate. We will perform sensitivity analyses of the combined model to test the robustness of the model, to assess the applicability of the model to other health care facilities, to reveal the variables on which the conclusions depend, and to suggest implementation strategies that may improve operational efficiency and cost-effectiveness.

该项目的目的是测量、估计和建模效果 一系列具体干预措施，包括实施 健康图片存档和通信系统（PACS） 患者的治疗结果以及放射科诊所的财务状况， 临床单位和医疗中心。 的三个主要组成部分 我们的方法是（1）根据估计和实际情况开发财务模型 每次干预前后的费用，（2）得出多元 评估 PACS 干预的独立影响的模型 健康结果替代物，以及 (3) 构建成本效益模型 整合了与相关的增量成本和健康结果 每次干预都针对一个指标。 首先，我们将估算设备、物资和人员的成本 来自实际费用信息（PACS 干预之前），以及来自 放射科的实际和预计需求（PACS 之后） 干预）。 这些数据将用于开发增量 从卫生系统的角度来看PACS的直接成本模型。 接下来，我们将测量现成的替代变量 可能与患者的健康结果高度相关： 住院率、住院时间（住院时间） 患者）、后续医疗保健的需求和费用。 将使用多变量分析来检测结果是否 代理人受到干预措施和其他因素的影响 已知会影响这些变量（例如案例组合）。我们的假设是 在控制了潜在的临床和人口统计学之后 患者之间的差异，PACS 干预后成像的患者 与干预前的成像相比，时间会更短 住院时间长、急诊就诊时间短、考试时间短，以及 降低护理成本。 最后，成本效益指标将 计算为每个诊断值的成本、每个过程增量的成本 改善，并作为每个健康结果替代的成本。 我们将表演 对组合模型进行敏感性分析，以检验模型的稳健性 模型，评估该模型对其他医疗保健的适用性 设施，揭示结论所依赖的变量，以及 提出可改善运营的实施策略 效率和成本效益。