Costs of measuring outcomes of acute hospital care in a longitudinal outcomes measurement system.

It is widely acknowledged that the measurement of outcomes of care and the comparison of outcomes over time within health care providers and risk-adjusted comparisons among providers are important parts of improving quality and cost-effectiveness of care. However, few studies have assessed the costs of measuring outcomes of care. We sought to evaluate the personnel and financial resources spent for a prospective assessment of outcomes of acute hospital care by health professionals in internal medicine. The study included 15 primary care hospitals participating in a longitudinal outcomes measurement program and 2005 patients over an assessment period with an average duration of 6 months. Each hospital project manager participated in a previously-tested structured 30-minute telephone interview. Outcome measures include time spent by the individual job titles in implementing and running the outcomes measurement program. Job-title-specific times were used to calculate costs from the hospitals' perspective. One-time costs (2132 +/- 1352 Euros) and administrative costs (95 +/- 97 Euros per week) varied substantially. Costs per patient were fairly stable at around 20 Euros. We estimated that the total cost for each hospital to assess outcomes of care for accreditation (10 tracer diagnoses over 6 months) would be 9700 Euros and that continuous monitoring of outcomes (5 tracer diagnoses) would cost 12,400 Euros per year. This study suggests that outcomes of acute hospital care can be assessed with limited resources and that standardized training programs would reduce variability in overall costs. This study should help hospital decision makers to estimate the necessary funding for outcomes measurement initiatives.

[Quality management in medical rehabilitation--a comparison of national and international approaches]. / Qualitätsmanagement in der medizinischen Rehabilitation--Vergleich internationaler und nationaler Konzepte.

The paper presents an integrated quality management program that is being run in acute-care hospitals and rehab facilities in Germany and in the U.S.. The experiences gained through all commonly implemented quality management concepts have been incorporated; which has allowed the development of comparison and integration tools. The overall experience indicates that the contents of good quality management are fairly independent of the concept applied and uniform as to their core. By using an integrated Quality Report, accreditation can be achieved while striving for excellence. The experiences gained through the KTQ Pilot Phase, the QMK Field Phase, and Joint Commission applications in Germany as well as in the hospitals of Pacific Health in the U.S. were incorporated. The sum total of experiences with more than 100 projects indicates that it is easy to combine two or more assessment models in such a manner as to reap the benefits of the models without incurring the expense of the extra work involved. The author recommends that German rehab facilities engage in quality assessment as soon as possible. Owing to insufficient clinical parameters in Baldrige and EFQM, crosswalk complementation with clinical evaluation instruments such as Joint Commission or KTQ and QMK is advisable.