Implementation of a quality improvement strategy in TAVI care was associated with lower 30-day all-cause mortality (1.5% vs 7.4%, P=0.055) and significantly reduced costs for pre-procedural visits.
Cohort (n=217)
No
Does a quality improvement strategy reduce patient-relevant cost drivers and improve clinical outcomes in patients undergoing TAVI?
A quality improvement strategy in TAVI care was associated with reduced costs for specific patient-relevant drivers and borderline significant improvements in 30-day mortality.
Absolute Event Rate: 1.5% vs 7.4%
p-value: p=0.055
BACKGROUND AND OBJECTIVE: Routine outcome monitoring is becoming standard in care evaluations, but costs are still underrepresented in these efforts. The primary aim of this study was therefore to assess if patient-relevant cost drivers can be used alongside clinical outcomes to evaluate an improvement project and to provide insight into (remaining) areas for improvement. METHODS: Data from patients who underwent transcatheter aortic valve implantation (TAVI) between 2013 and 2018 at a single center in the Netherlands were used. A quality improvement strategy was implemented in October 2015, and pre- (A) and post-quality improvement cohorts (B) were distinguished. For each cohort, clinical outcomes, quality of life (QoL), and cost drivers were collected from the national cardiac registry and hospital registration data. The most appropriate cost drivers in TAVI care were selected from hospital registration data using a novel stepwise approach with an expert panel of physicians, managers, and patient representatives. A radar chart was used to visualize the clinical outcomes, QoL and the selected costs drivers. RESULTS: We included 81 patients in cohort A and 136 patients in cohort B. All-cause mortality at 30 days was borderline significantly lower in cohort B than in cohort A (1.5% vs 7.4%, P = .055). QoL improved after TAVI for both cohorts. The stepwise approach resulted in 21 patient-relevant cost drivers. Costs for pre-procedural outpatient clinic visits (€535, interquartile range IQR = 321-675, vs €650, IQR = 512-890, P < .001), costs for the procedure (€1354, IQR = 1236-1686, vs €1474, IQR = 1372-1620, P < .001), and imaging during admission (€318, IQR = 174-441, vs €329, IQR = 267-682, P = .002) were significantly lower in cohort B than in cohort A. Possible improvement potential was seen in 30-day pacemaker implantation and 120-day readmission. CONCLUSION: A selection of patient-relevant cost drivers is a valuable addition to clinical outcomes for use in evaluation of improvement projects and identification of room for further improvement.
Steenbergen et al. (Thu,) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=217). Quality improvement strategy vs. Pre-quality improvement care was evaluated on All-cause mortality at 30 days (p=0.055). Implementation of a quality improvement strategy in TAVI care was associated with lower 30-day all-cause mortality (1.5% vs 7.4%, P=0.055) and significantly reduced costs for pre-procedural visits.