Characteristics, Clinical & Cost Effectiveness Assessment of a Community Ambulatory Surgery Center Compared with a Public.

Transcription

1 Characteristics, Clinical & Cost Effectiveness Assessment of a Community Ambulatory Surgery Center Compared with a Public { Hospital Kesner D 1, Shapira C 2, Kaufman L 1, Milman U Zvulun medical center 2. Carmel medical center 3. Research Unit, Clalit Health Services, Haifa & Western Galilee district

2 Disclaimer This study was funded by : Gertner Institute for Epidemiology and Health Policy Research

3 Background Healthcare costs and new technologies enabled shift to outpatients facilities. Zvulun Medical Center has 3 active ambulatory operating theaters for the last 10 years. Similar ambulatory operations are also done at Carmel hospital, a public hospital [owned by Clalit]. The quality, adequacy and cost of both systems was not compared in Israel.

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5 QUALITY ADEQUACY (Age, Demographic characteristics, Medical History, Operative Risk). SATISFACTION COST {

6 FLOW CHART eligible for research (n=3315) patients recruitment Excluded=190,6%) cohort n=3125,94% CARMEL ZVULUN distribution according to site research group 2 (n=1095,33%) research group 1 (n=2030,61%) were treated (n=1095,33%) were treated (n=2030,61%) dropped (n=0) dropped (n=0) first follow up (one month after surgery) participated in research (n=1030,31%) dropped(lost contact) (n=50,1.5%) refusal to continue (n=140,4%) death (n=1,0.03%) participated in research (n=1941,59%) dropped(lost contact) (n=75,2%) refusal to continue (n=14,0.4%) death (n=0)

7 second follow up (6 month after surgery) participated in research (n=976,29%) Dropped (lost contact) (n=44,1%) refusal to continue (n=2,0.06%) death (n=8,0.2%) participated in research (n=1837,55%) Dropped (lost contact) (n=94,3%) refusal to continue (n=5,0.2%) death (n=5,0.2%) data analysis data that was analyzed (n=976,29%) were taken off the analysis (n=0,0%) data that was analyzed (n=1837,55%) were taken off the analysis (n=0,0%) the percentage of the participants - 85% in all the sample & at every site separately the percentage in the chart were calculated from n=3315 patients who arrived for surgery

8 Operations that were sampled Hysteroscopy Children Hernia Adult Hernia Cataract Adenoidectomy Tube Insertion Trigger Finger Carpal Tunnel

9 There were no major differences in terms of: Basic demographic characterizations Complications ]Immediate or late] Waiting period to operation Patient Satisfaction

10 Local anesthesia was used in 71% of the CAS operations compared with 50% in hospital. Most of the patients who were operated in the CAS and in the hospital will prefer the same site again. CAS patients lost slightly more days from work.

11 receiving explanations about the operation before the procedure day of surgery.one week before op>.one-two weeks before op two weeks-two month before two month -six month before six month -1 year before year 1< recurrent operation did not receive explanation ZVULUN n % 45 2% 134 7% % % % 136 7% 62 3% 112 6% % x²=86.7,p<.001 CARMEL n % 42 4% 75 8% 55 6% % % % 27 3% 72% 7% %

12 Cost Analysis The players The ministry of Health (MOH) the primary insurer of all the Israeli population. The HMO s - contractors of the MOH; actual providers of healthcare. The Hospitals private, owned by MOH or by HMO's); Each with its economic interests despite the fact the most are, by definition, a non profit organizations

13 Cost Analysis a New player? In to this field of giants, the Community Ambulatory Medical Center was introduced as a new provider of, what is traditionally considered, hospital merchandise. We have shown that the Ambulatory medical center is not inferior in terms of quality but, is it cost effective?

14 Cost Analysis The Rules The official price - published by the Ministry of Health. Is the basis for pricing of health care products, including surgical procedures. The financial policy in the public health system, that is based upon capping, is the basis for the actual cost.

15 Cost Analysis Mind the Gap The difference in salaries, overhead and other factors make the difference in the actual cost. It should be noted that the cost of the procedures in the ambulatory center is the actual cost, and it is lower by about 20% than in hospital. 20% difference may result in a substantial saving potential.

16 Conclusions The low complications rate suggests that patient's selection for ambulatory operation or hospital was appropriate. Community Ambulatory Service operations contribute to a better use of resources considering the lower cost of the ambulatory setting.

17 Who gave the explanation ZVULUN CARMEL n % n % family practitioner 63 4% 13 2% surgeon % % nurse 142 9% 9 1% other % 6 1% χ²=152.3, p <.001

18 surgery site preference by patients surgery site ZVULUN CARMEL n % N % if could choose what ambulatory % % would you prefer hospital 139 8% % ambulatory or hospital no difference 47 3% 0 0% surgery? doesn't know 24 1% 3 0% if ambulatory community % % in the community hospital 138 8% % or the hospital no difference 49 3% 37 4% doesn't know 24 1% 7 1% 85% would prefer ambulatory surgery(89% from zvulun,77% from carmel) in case of ambulatory surgery 63% prefer in the community (89% from zvulun,15% from carmel)

19 carmel zvulun X² % n % n **9.8 39% % 830 male gender 61% % 1006 female ns6.7 67% % 1151 Jewish religion 6% 60 7% 119 Christian 20% % 432 Muslim 7% 64 7% 122 Druze 0% 3% 0% 4 other ** % % < age 14% % % % % % % % > ***31.1 7% 58 4% 61 no formal education education 21% % 367 years 8< 43% % 777 high school 17% % 227 first degree 13% % 174 second degree + Surgery site

20 DOCTOR VISIT AFTER THE OPERATION SURGERY SITE ZVULUN CARMEL n % n % family no visit % % pratitioner 1 visit % % 2-3 visits % % 4+ visits 69 4% 41 4% surgeon no visits % % 1 visit % % 2-3 visits % % 4+ visits 85 5% 25 3% CARMEL PATIENTS WENT MORE TO FAMILY PRACTITIONER ZVULUN PATIENTS WENT MORE TO THE SURGEON