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首页> 外文期刊>Journal of Clinical Medicine Research >Using Time-Driven Activity-Based Costing as a Key Component of the Value Platform: A Pilot Analysis of Colonoscopy, Aortic Valve Replacement and Carpal Tunnel Release Procedures
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Using Time-Driven Activity-Based Costing as a Key Component of the Value Platform: A Pilot Analysis of Colonoscopy, Aortic Valve Replacement and Carpal Tunnel Release Procedures

机译：将基于时间的基于活动的成本计算作为价值平台的关键组成部分：结肠镜检查，主动脉瓣置换和腕管释放程序的初步分析

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Background: Time-driven activity-based costing (TDABC) is a methodology that calculates the costs of healthcare resources consumed as a patient moves along a care process. Limited data exist on the application of TDABC from the perspective of an anesthesia provider. We describe the use of TDABC, a bottom-up costing strategy and financial outcomes for three different medical-surgical procedures.Methods: In each case, a multi-disciplinary team created process maps describing the care delivery cycle for a patient encounter using the TDABC methodology. Each step in a process map delineated an activity required for delivery of patient care. The resources (personnel, equipment and supplies) associated with each step were identified. A per minute cost for each resource expended was generated, known as the capacity cost rate, and multiplied by its time requirement. The total cost for an episode of care was obtained by adding the cost of each individual resource consumed as the patient moved along a clinical pathway.Results: We built process maps for colonoscopy in the gastroenterology suite, calculated costs of an aortic valve replacement by comparing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR) techniques, and determined the cost of carpal tunnel release in an operating room versus an ambulatory procedure room.Conclusions: TDABC is central to the value-based healthcare platform. Application of TDABC provides a framework to identify process improvements for health care delivery. The first case demonstrates cost-savings and improved wait times by shifting some of the colonoscopies scheduled with an anesthesiologist from the main hospital to the ambulatory facility. In the second case, we show that the deployment of an aortic valve via the transcatheter route front loads the costs compared to traditional, surgical replacement. The last case demonstrates significant cost savings to the healthcare system associated with re-organization of staff required to execute a carpal tunnel release.J Clin Med Res. 2018;10(4):314-320doi: https://doi.org/10.14740/jocmr3350w.
机译：背景：时间驱动的基于活动的成本计算（TDABC）是一种方法，用于计算患者在护理过程中移动时消耗的医疗资源的成本。从麻醉提供者的角度来看，有关TDABC应用的数据有限。我们描述了TDABC的使用，自下而上的成本策略和三种不同医疗手术方法的财务结果。方法：在每种情况下，多学科团队创建流程图，描述使用TDABC的患者遭遇的护理交付周期。方法。流程图中的每个步骤都描述了提供患者护理所需的活动。确定了与每个步骤相关的资源（人员，设备和用品）。生成的每种资源的每分钟成本（称为容量成本率）乘以其时间要求。结果：我们在胃肠病学套件中建立了结肠镜检查的过程图，并通过比较计算了主动脉瓣置换的费用，从而获得了护理总费用。外科主动脉瓣置换术（SAVR）与经导管主动脉瓣置换术（TAVR）的比较，并确定了手术室和非手术室的腕管释放成本。结论：TDABC对于基于价值的医疗平台至关重要。 TDABC的应用提供了一个框架，用于识别医疗保健提供过程的改进。第一种情况通过将安排麻醉医生安排的一些结肠镜检查从主医院转移到门诊设施，从而节省了成本并缩短了等待时间。在第二种情况下，我们表明，与传统的外科手术置换相比，通过经导管路径前部部署主动脉瓣会增加成本。最后一个案例表明，与执行腕管隧道释放所需的人员重组相关的医疗系统可节省大量成本。JClin Med Res。 2018; 10（4）：314-320doi：https://doi.org/10.14740/jocmr3350w。

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