title: Transforming Patient Value: Comparison of Hospital, Surgical, and General Surgery Patients.
abstract: BACKGROUND
  Patient value (V) is enhanced when quality (Q) is increased and cost (C) is diminished (V = Q/C). However, calculating value has been inhibited by a lack of risk-adjusted cost data. The aim of this analysis was to measure patient value before and after implementation of quality improvement and cost reduction programs.
  
  
  METHODS
  Multidisciplinary efforts to improve patient value were initiated at a safety-net hospital in 2012. Quality improvement focused on adoption of multiple best practices, and minimizing practice variation was the strategy to control cost. University HealthSystem Consortium (UHC) risk-adjusted quality (patient mortality + safety + satisfaction + effectiveness) and cost (length of stay + direct cost) data were used to calculate patient value over 3 fiscal years. Normalized ranks in the UHC Quality and Accountability Scorecard were used in the value equation.
  
  
  RESULTS
  For all hospital patients, quality scores improved from 50.3 to 66.5, with most of the change occurring in decreased mortality. Similar trends were observed for all surgery patients (42.6 to 48.4) and for general surgery patients (30.9 to 64.6). For all hospital patients, cost scores improved from 71.0 to 2.9. Similar changes were noted for all surgical (71.6 to 27.1) and general surgery (85.7 to 23.0) patients. Therefore, value increased more than 30-fold for all patients, 3-fold for all surgical patients, and almost 8-fold for general surgery patients.
  
  
  CONCLUSIONS
  Multidisciplinary quality and cost efforts resulted in significant improvements in value for all hospitalized patients as well as general surgery patients. Mortality improved the most in general surgery patients, and satisfaction was highest among surgical patients.
authors.affiliation: Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA; Temple University Health System, Philadelphia, PA. Electronic address: Henry.Pitt@tuhs.temple.edu.
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.affiliation: Temple University Health System, Philadelphia, PA.
authors.forename: Ella
authors.initials: E
authors.lastname: Tsypenyuk
authors.affiliation: Temple University Health System, Philadelphia, PA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Freeman
authors.affiliation: Temple University Health System, Philadelphia, PA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Carson
authors.affiliation: Temple University Health System, Philadelphia, PA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Shinefeld
authors.affiliation: Temple University Health System, Philadelphia, PA.
authors.forename: Sally M
authors.initials: SM
authors.lastname: Hinkle
authors.affiliation: Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Powers
authors.affiliation: Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Goldberg
authors.affiliation: Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA; Temple University Health System, Philadelphia, PA.
authors.forename: Verdi J
authors.initials: VJ
authors.lastname: DiSesa
authors.affiliation: Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA; Temple University Health System, Philadelphia, PA.
authors.forename: Larry R
authors.initials: LR
authors.lastname: Kaiser
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D004180:Direct Service Costs; D005260:Female; D013502:General Surgery; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D017060:Patient Satisfaction; D058996:Quality Improvement; D020379:Risk Adjustment; D064876:Safety-net Providers; D016896:Treatment Outcome