Creating patient value in glaucoma care: applying quality costing and care delivery value chain approaches--a five-year case study in the Rotterdam Eye Hospital.
OBJECTIVE
The purpose of this paper is to explore in a specific hospital care process the applicability in practice of the theories of quality costing and value chains.


METHODS
In a retrospective case study an in-depth evaluation of the use of a quality cost model (QCM) and the applicability of Porter's care delivery value chain (CDVC) was performed in a specific care process: glaucoma care over the period 2001 to 2006 in the Rotterdam Eye Hospital in The Netherlands.


RESULTS
The case study shows a reduction of costs per product by increasing the number of outpatient visits and surgery combined with a higher patient satisfaction. Reduction of costs of non-compliance by using the QCM is small, due to the absence of (external) financial incentives for both the hospital and individual physicians. For CDVC to be supportive to an integrated quality and cost management the notion "patient value" needs far more specification as mutually agreed on by the stakeholders involved and related reimbursement needs to depend on realised outcomes.


CONCLUSIONS
The case study just focused on one specific care process in one hospital. To determine effects in other areas of health care, it is important to study the use and applicability of the QCM and the CDVC in other care processes and settings.


CONCLUSIONS
QCM and a CDVC can be useful tools for hospital management to manage the outcomes on both quality and costs, but impact is dependent on the incentives in the context of the existing organisational and reimbursement system and asks for an agreed on operationalisation among the various stakeholders of the notion of patient value.
de Korne
Dirk F
DF
Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands. d.dekorne@oogziekenhuis.nl
Sol
Kees
K
Custers
Thomas
T
van Sprundel
Esther
E
van Ineveld
B Martin
BM
Lemij
Hans G
HG
Klazinga
Niek S
NS
D003365:Costs and Cost Analysis; D003625:Data Collection; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D005901:Glaucoma / Q000628:therapy*; D006297:Health Services Accessibility / Q000458:organization & administration; D006301:Health Services Needs and Demand / Q000458:organization & administration; D006801:Humans; D009426:Netherlands; D019982:Organizational Case Studies; D017060:Patient Satisfaction; D017064:Process Assessment, Health Care / Q000458:organization & administration; D019984:Quality Indicators, Health Care / Q000458:organization & administration; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration*; D012052:Reimbursement, Incentive; D012189:Retrospective Studies