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The American Journal of Managed Care February 2019
Impact of Hepatitis C Virus and Insurance Coverage on Mortality
Haley Bush, MSPH; James Paik, PhD; Pegah Golabi, MD; Leyla de Avila, BA; Carey Escheik, BS; and Zobair M. Younossi, MD, MPH
Does CMS’ Meaningful Measures Initiative Boil Down to Cost-Benefit Analysis?
Jackson Williams, JD
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A. Mark Fendrick, MD; and Darrell George, BA
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Sachin H. Jain, MD, MBA
Value-Based Arrangements May Be More Prevalent Than Assumed
Nirosha Mahendraratnam, PhD; Corinna Sorenson, PhD, MHSA, MPH; Elizabeth Richardson, MSc; Gregory W. Daniel, PhD, MPH, RPh; Lisabeth Buelt, MPH; Kimberly Westrich, MA; Jingyuan Qian, MPP; Hilary Campbell, PharmD, JD; Mark McClellan, MD, PhD; and Robert W. Dubois, MD, PhD
Medication Adherence as a Measure of the Quality of Care Provided by Physicians
Seth A. Seabury, PhD; J. Samantha Dougherty, PhD; and Jeff Sullivan, MS
Why Aren’t More Employers Implementing Reference-Based Pricing Benefit Design?
Anna D. Sinaiko, PhD, MPP; Shehnaz Alidina, SD, MPH; and Ateev Mehrotra, MD, MPH
Does Comparing Cesarean Delivery Rates Influence Women’s Choice of Obstetric Hospital?
Rebecca A. Gourevitch, MS; Ateev Mehrotra, MD, MPH; Grace Galvin, MPH; Avery C. Plough, BA; and Neel T. Shah, MD, MPP
Are Value-Based Incentives Driving Behavior Change to Improve Value?
Cheryl L. Damberg, PhD; Marissa Silverman, MSPH; Lane Burgette, PhD; Mary E. Vaiana, PhD; and M. Susan Ridgely, JD
Validating a Method to Assess Disease Burden From Insurance Claims
Thomas E. Kottke, MD, MSPH; Jason M. Gallagher, MBA; Marcia Lowry, MS; Pawan D. Patel, MD; Sachin Rauri, MS; Juliana O. Tillema, MPA; Jeanette Y. Ziegenfuss, PhD; Nicolaas P. Pronk, PhD, MA; and Susan M. Knudson, MA
Performance of the Adapted Diabetes Complications Severity Index Translated to ICD-10
Felix Sebastian Wicke, Dr Med; Anastasiya Glushan, BSc; Ingrid Schubert, Dr Rer Soc; Ingrid Köster, Dipl-Stat; Robert Lübeck, Dr Med; Marc Hammer, MPH; Martin Beyer, MSocSc; and Kateryna Karimova, MSc
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Process Reengineering and Patient-Centered Approach Strengthen Efficiency in Specialized Care
Jesús Antonio Álvarez, PhD, MD; Rubén Francisco Flores, PhD; Jaime Álvarez Grau, PhD; and Jesús Matarranz, PhD

Process Reengineering and Patient-Centered Approach Strengthen Efficiency in Specialized Care

Jesús Antonio Álvarez, PhD, MD; Rubén Francisco Flores, PhD; Jaime Álvarez Grau, PhD; and Jesús Matarranz, PhD
Improving efficiency is complex and requires a multimodal approach. Health information systems, patient feedback, and multidisciplinary teams are components that can improve clinical processes.
ABSTRACT

Objectives: To improve multiple levels of utilization and efficiency in specialized outpatient consults using information technology–based systems, process reengineering, and patient-centeredness.

Study Design: Prospective research from 2008 to 2014 conducted in a hospital in Madrid, Spain. Quantitative analysis of 1,162,477 consecutive consultation requests and qualitative techniques of 72,368 surveys using a structured questionnaire.

Methods: Key performance indicators were evaluated: operational outcomes (productivity, time gap between requested consultations and performance, staffing accuracy, wait time, and underlying variability), administrative burden (downtime losses; no-show, drop-in, cancelled, and rescheduled visits), perceived quality scores, and income. Data mining, modeling seasonality in demand, process reengineering, and a patient-centered approach were incorporated as strategies to drive changes.

Results: Productivity increased 34% for the entire period, closing the gap between consultation request and performance from 43.7% to 8.7%. Wait time decreased from 82.7 to 7.9 days, with an 82.9% reduction in interservice variability. Staffing adjustments prevented understaffing situations; more accurate modeling reduced understaffing from 282 to 4 full-time equivalent staff. A seasonal autoregressive integrated moving average (1,0,0)(0,1,0) model explained 90.3% of forecasted data variability with an absolute percentage error between 2.4% and 8.3%. The project reduced administrative burden, inefficiency, and downtime losses by 47.3%, 53.7%, and 54.5%, respectively. Perceived quality indices improved by 19.6%, and complaints were reduced from 63 to 10 per 10,000 consultation-years. Hospital incomes rose by 49.4%.

Conclusions: Improving efficiency is complex and requires a multimodal approach. Health information systems, patient feedback, and multidisciplinary teams are components that can improve clinical processes.

Am J Manag Care. 2019;25(2):e50-e57

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