Daly/Cost comparison in the management of peripheral arterial disease at 17 Belgian hospitals.

OBJECTIVE: Peripheral arterial disease (PAD) is a manifestation of atherosclerosis that affects the lower extremities and afflicts more than 200 million people worldwide. Because of limited resources, the need to provide quality care associated with cost control is essential for health policies. Our study concerns an interhospital comparison among seventeen Belgian hospitals that integrates the weighting of quality indicators and the costs of care, from the hospital perspective, for a patient with this pathology in 2018. METHODS: The disability-adjusted life years (DALYs) were calculated by adding the number of years of life lost due to premature death and the number of years of life lost due to disability for each in-hospital stay. The DALY impact was interpreted according to patient safety indicators. We compared the hospitals using the adjusted values ​​of costs and DALYs for their case mix index, obtained by relating the observed value to the predicted value obtained by linear regression. RESULTS: We studied 2,437 patients and recorded a total of 560.1 DALYs in hospitals. The in-hospital cost average [standard deviation (SD)] was €8,673 (€10,893). Our model identified the hospitals whose observed values were higher than predicted; six needed to reduce the costs and impacts of DALYs, six needed to improve one of the two factors, and four seemed to have good results. The average cost (SD) for the worst performing hospitals amounted to €27,803 (€28,358). CONCLUSIONS: Studying the costs of treatment according to patient safety indicators permits us to evaluate the entire chain of care using a comparable unit of measurement.

Methodology for restarting hospital activities after a pandemic: COVID-19 experience.

In addition to the health responsibility of hospitals in managing this COVID-19 crisis, hospital managers must also ensure the financial viability of healthcare structures. This is why, at the dawn of a lockdown exit, managers must anticipate the identification of recovery scenarios. This point refers in particular to the selection and scale of progression of hospital activities, and also to the impacts this will have on staff and patients in the short and medium term. Unfortunately, there is a serious lack of literature on the subject. The aim of this document is therefore to propose a methodology for resuming the medical, economic and social activities of a healthcare network or hospital. In our approach, we identify 6 stages following the COVID-19 peak: assessment of the situation, Act 2, development of scenarios-criteria-conditions, restarting, continuous improvement, and transversal activities. The entirety of our developed methodology is supported by a pragmatic approach with, in particular, the creation of specific tools for each stage of the process. This strategy and these tools have been created with the operational players and adapted to meet the specific features of each hospital while respecting the coherence of the healthcare network's decisions. We are convinced that this approach can be exported on a larger scale to inspire other healthcare networks and other hospitals that have also found themselves without the weapons to prepare for the resumption of hospital activities.

Cost-DALY comparison of hip replacement care in 12 Belgian hospitals.

BACKGROUND: In view of the expected increase in expenditure on hip replacement treatment in Belgium, the complication rate and potential waste reduction, as estimated by the Organisation for Economic Cooperation and Development, we are not yet in a position to assess the efficiency of hip replacement treatment in Belgian hospitals. This objective study uses a cost-disability-adjusted life years (DALYs) ratio to propose a comparison of hip replacement surgery among 12 Belgian hospitals. METHODS: Our study seeks to innovate by proposing an interhospital comparison that simultaneously integrates the weighting of quality indicators and the costs of managing a patient. To this end, we associated a DALY impact with each patient safety indicator, readmission and mortality outcome. We then compared hospitals using both costs and DALYs adjusted to their case mix index. The adjusted values (costs and DALYs) were obtained by relating the observed value to the predicted value obtained from the linear regression model. RESULTS: We registered a total of 246.5 DALYs for the 12 hospital institutions, the average cost (SD) of a stay being €8013 (€4304). Our model allowed us to identify hospitals with observed values higher than those predicted. Out of the 12 hospitals evaluated, 4 need to reduce costs and DALYs impacts, 6 have to improve one of the two factors and 2 appear to have good results. The costs for the worst performing hospitals can rise to over €150 000. CONCLUSION: Evaluating the rates of patient safety indicators, associated with cost, is a prerequisite for quality and cost improvement efforts on the part of managers and practitioners. However, it appears essential to evaluate the entire care chain using a comparable unit of measurement. The hospital's case mix index must also be considered in benchmarking to avoid drawing the wrong conclusions. In addition, other indicators, such as the patient's perception of the actual results, should be added to our study.