Nama Jurnal
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Judul Jurnal
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Tahun
Published
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Pokok Bahasan
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Summary /
Kesimpulan
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Saran
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World
Journal of Surgery
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Reducing
Healthcare Costs Facilitated by Surgical Auditing:
A
Systematic Review
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2015
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Many
articles have been published describing a relationship between surgical
auditing and quality improvement
Goal
in health care should be maximizing value for patients.
The
healthcare industry has been lagging behind regarding the availability of key
data on process and outcomes of care, when compared to other industries where
product evaluation is standardly embedded in the production process.
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In
this systematic review, a relationship between surgical auditing and reduced
healthcare costs was identified.
Though
frequently assumed in the literature, only six articles actually described
this relationship. All identified studies suggest that besides quality
improvement, surgical auditing has the potential to reduce in-hospital costs.
Surgical
audits facilitate this process and, most important, surgical auditing might
lead to improved outcomes for patients. Whether this involves orthopedic surgery
[22], colorectal surgery [6], vascular surgery [16], or general surgery [9,
10, 17, 18], all show an association
with
improved clinical outcome.
Because
of the cost- and time-consuming exercise of data collection [23], the use of surgical
auditing as a quality instrument will catalyze only when it proves to be
cost-effective. Four of the identified articles [17, 18, 20, 21] incorporated
costs of the audit itself in their calculations and therefore analyzed the
actual costeffectiveness of surgical audits. These four studies showed
larger
reduction in costs (due to quality improvement) compared to the audit participation-costs,
and therefore overall cost reduction was established.
A
factor that attributed to the high reduction in costs in this study might be
the selection of colorectal cancer patients. In high-risk procedures, like
colorectal cancer resections, the prevention of adverse events, such as
anastomotic leakage, might be of greater clinical [24] and financial impact.
Although
we only identified articles focused on hospitalrelated costs, registries that
cover the complete patient cycle should provide better insights. Long-term
complications can be identified which might cover ‘hidden’ longterm costs.
For example, in colorectal cancer surgery, the creation of a defunctioning stoma
shortens length of hospital stay during the initial operation and lowers
short-term complications [38].
However,
next to the impact on quality of life a stoma has, it also has serious
long-term financial implications. Patients have a life time need for
colostomy pouches and a constant risk for long-term complications [39] which
are seen in up to fifty percent of the patients
within
ten year follow up [40]. Increasing quality and reducing costs is the
fundamental base of ‘value based health care’ [7]. Therefore, covering short-
as well as long term
outcomes
should be aimed for all health care evaluations.
While
surgical auditing has become more integrated
in common practice, its effectiveness on costs needs to be evaluated as well,
and perhaps costs evaluation has to be
incorporated
in the feedback mechanisms of the audit.
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In
future, widespread introduction and continuous use of surgical auditing is
required to evaluate and improve quality of medical care for patients.
The
main focus should be evaluation of high-risk procedures since prevention of
adverse events in these procedures will have greater clinical and financial
impact compared to lowrisk procedures.
Moreover,
when financial outcomes are incorporated in the
audit,
calculating those financial outcomes should be based
on
actual costs, for example using time-driven activitybased
costing.
In the future, covering the complete cycle of care and incorporating cost
analyses and patient related outcome measures would increase the audits’
value and provide a complete overview of the value of healthcare.
Further
studies describing the audit’s value should include all of the above-mentioned
elements, in order to provide more robust evidence for further implementation
of auditing
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Senin, 30 Maret 2015
Reducing Healthcare Costs Facilitated by Surgical Auditing: A Systematic Review
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