title: Acute coronary syndrome pathways: alignment with a bundled care reimbursement model.
abstract: Changes in public policy, population demographics, and market dynamics are spurring innovative approaches to value-based care. Annually, hospitalizations for Acute Coronary Syndromes (ACS) account for a substantial proportion of healthcare expenditures in the United States. Vanderbilt University Medical Center has developed a framework to deliver comprehensive care incorporating inpatient and outpatient care teams for patients with ACS under an episode-based, bundled reimbursement model for a term of 6 months. As such, a value-oriented pathway was created with the goals of (1) optimizing patient outcomes following ACS; (2) minimizing complications from the treatment of ACS; and (3) reducing costs of healthcare related to the treatment of ACS. In a tertiary care academic medical system receiving patients from multiple facilities involving multiple providers, standardization of care by using practice guidelines and evidence-based data coupled with a robust computerized provider order entry system provides a unique opportunity to produce a "best practice" algorithm for treating patients presenting with ACS. Presented in this study are in-hospital and postdischarge care pathways for treating a diverse group of patients presenting with ACS to our institution.
authors.affiliation: From the Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
authors.forename: Pete P
authors.initials: PP
authors.lastname: Fong
authors.forename: Emily Blake
authors.initials: EB
authors.lastname: Jackson
authors.forename: Keith B
authors.initials: KB
authors.lastname: Churchwell
authors.forename: Robin
authors.initials: R
authors.lastname: Steaban
authors.forename: John M
authors.initials: JM
authors.lastname: Starmer
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Johnson
authors.forename: Julie D
authors.initials: JD
authors.lastname: McNeil
authors.forename: Zachary W
authors.initials: ZW
authors.lastname: Klint
authors.forename: Sonia L
authors.initials: SL
authors.lastname: Scalf
authors.forename: Carol M
authors.initials: CM
authors.lastname: Parsons
authors.forename: Susan
authors.initials: S
authors.lastname: Cortez
authors.forename: Donna
authors.initials: D
authors.lastname: Christensen
authors.forename: Tina
authors.initials: T
authors.lastname: French
authors.forename: John A
authors.initials: JA
authors.lastname: McPherson
mesh_terms: D054058:Acute Coronary Syndrome / Q000191:economics* / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D019091:Critical Pathways; D017050:Episode of Care; D019317:Evidence-Based Medicine; D006801:Humans; D007297:Inpatients; D010045:Outpatients; D005791:Patient Care / Q000191:economics*; D012051:Reimbursement Mechanisms