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Costs of Measuring Outcomes of Acute Hospital Care in a Longitudinal Outcomes Measurement System

Department of Epidemiology, Harvard School of Public Health, Boston, Mass, and the Outcomes Research Group, Bavarian Public Health Research Center, Ludwig-Maximilians University of Munich, Germany; Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue (BLI-341), Boston, MA 02115 schneeweiss~post.harvard.edu

Astrid Manstetten, MA

Outcomes Research Group, Bavarian Public Health Research Center, Ludwig-Maximilians-University of Munich, Germany

Manfred Wildner, MD, MPH

Outcomes Research Group, Bavarian Public Health Research Center, Ludwig-Maximilians-University of Munich, Germany, and the Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians University of Munich, Germany

Oliver Sangha, MD, MPH, ScD

Outcomes Research Group, Bavarian Public Health Research Center, Ludwig-Maximilians-University of Munich, Germany, and the Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University of Munich, Germany

Michael Liebetrau, MD

HELIOS Kliniken GmbH, Fulda, Germany

Axel Paeger, MD, MBA

ASKLEPIOS Kliniken GmbH, Lich, Germany

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 (C2132 + 1352) and administrative costs (95 97 per week) varied substantially. Costs per patient were fairly stable at around 20. 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 and that continuous monitoring of outcomes (5 tracer diagnoses) would cost 12,400 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.

Key Words: Costs • measurement • outcomes research • quality of care

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