This presentation is part of: Poster Session - CEA: Methods and Applications; Health Services Research
OUTCOMES OF A MULTIDISCIPLINARY PHYSICIAN-LED PRACTICE MANAGEMENT INTERVENTION TO CONTROL COSTS DURING AN ERA OF RAPID TECHNOLOGIC EVOLUTION IN CORONARY INTERVENTIONS
Celia C Kamath, PhD1, Charanjit S. Rihal, M.D.2, Kathy Reller, RN3, Stephanie S Anderson, MA1, Erin K. McMurtry, B.S.1, John F. Bresnahan, M.D.2, David R. Holmes, M.D.2, and Kirsten Hall Long, Ph.D.1. (1) Mayo Clinic College of Medicine, Health Sciences Research, Rochester, MN, (2) Mayo Clinic College of Medicine, Cardiovascular Diseases, Rochester, MN, (3) Mayo Clinic College of Medicine, Administration, Rochester, MN
Purpose: Increasing costs associated with percutaneous coronary interventions (PCIs) have been of concern to health care institutions. A physician led intervention resulting in revised practice guidelines and cost-containment efforts was initiated in an academic referral center, at the same time that new coronary intervention technology (stents and glycoprotein IIb/IIIa inhibitors) was being introduced. This study compares the clinical and economic outcomes associated with PCI procedures in pre and post intervention cohorts. Methods: Clinical and angiographic data on 1426 pre-intervention and 1738 post-intervention patients were derived from the Mayo Clinic PCI registry. Administrative data and a standardized 2000 constant dollar cost estimate was used to value utilization, in particular to estimate total procedural and post-procedural costs and length of stay (LOS). T-tests were used to compare demographic, clinical and angiographic characteristics as well as to compare observed procedural success rates and economic outcomes between cohorts. Logistic regression and generalized linear modeling was used to estimate the impact of the intervention on procedural success and total costs, respectively, while controlling for patient demographic, clinical, and angiographic characteristics. Results: The two cohorts were similar in terms of age (66 years), % male (70%), CHF on presentation (8%) and diabetes (23%). The post-intervention cohort had a higher % of patients who received stents (88% vs. 77%), urgent PCIs (48 % vs. 36%), prior PTCA (31% vs. 27%), glycoprotein after PCI (34% vs. 30%), hypertension (64 % vs. 59%), moderate/severe bend in any lesion (48% vs. 41%), and ulcer in any lesion (15% vs. 10%). Procedural success was observed in 91% of patients in both cohorts and did not statistically differ in adjusted analyses. Observed costs per patient were, on average $2,031 lower post-intervention (p<0.001). Model results confirmed a significant economic advantage in the post-intervention period, with a predicted LOS difference of 0.90 days (3.4 vs 2.5; p<0.001) and predicted cost savings of $4,667 (95% confidence interval of difference: $4218, $5116) Conclusion: Physician-led practice management efforts were successful at containing PCI related costs of care in an era of rapid introduction of new technology while maintaining quality of care. This case study on the process and outcome of cost containment efforts may have implications beyond the cardiovascular setting, to other healthcare settings.
