title: Time-driven activity-based costing: A dynamic value assessment model in pediatric appendicitis.
abstract: OBJECTIVE
  Healthcare reform policies are emphasizing value-based healthcare delivery. We hypothesize that time-driven activity-based costing (TDABC) can be used to appraise healthcare interventions in pediatric appendicitis.
  
  
  METHODS
  Triage-based standing delegation orders, surgical advanced practice providers, and a same-day discharge protocol were implemented to target deficiencies identified in our initial TDABC model. Post-intervention process maps for a hospital episode were created using electronic time stamp data for simple appendicitis cases during February to March 2016. Total personnel and consumable costs were determined using TDABC methodology.
  
  
  RESULTS
  The post-intervention TDABC model featured 6 phases of care, 33 processes, and 19 personnel types. Our interventions reduced duration and costs in the emergency department (-41min, -$23) and pre-operative floor (-57min, -$18). While post-anesthesia care unit duration and costs increased (+224min, +$41), the same-day discharge protocol eliminated post-operative floor costs (-$306). Our model incorporating all three interventions reduced total direct costs by 11% ($2753.39 to $2447.68) and duration of hospitalization by 51% (1984min to 966min).
  
  
  CONCLUSIONS
  Time-driven activity-based costing can dynamically model changes in our healthcare delivery as a result of process improvement interventions. It is an effective tool to continuously assess the impact of these interventions on the value of appendicitis care.
  
  
  METHODS
  II, Type of study: Economic Analysis.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr. Suite 1210, Houston, TX 77030.
authors.forename: Yangyang R
authors.initials: YR
authors.lastname: Yu
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr. Suite 1210, Houston, TX 77030.
authors.forename: Paulette I
authors.initials: PI
authors.lastname: Abbas
authors.affiliation: Decision Support and Cost Accounting, Texas Children's Hospital, 1919 S. Braeswood, MB6206, Houston, TX 77030.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Smith
authors.affiliation: Outcomes and Impact Service, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Dr, Suite 650, Houston, TX 77030.
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Carberry
authors.affiliation: Department of Finance, Texas Children's Health Plan, Texas Children's Hospital, 6330 W. Loop South, Suite 800, Bellaire, TX 77401.
authors.forename: Hui
authors.initials: H
authors.lastname: Ren
authors.affiliation: Section of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Dr. Suite A210, Houston, TX 77030.
authors.forename: Binita
authors.initials: B
authors.lastname: Patel
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr. Suite 1210, Houston, TX 77030.
authors.forename: Jed G
authors.initials: JG
authors.lastname: Nuchtern
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, 6701 Fannin Dr. Suite 1210, Houston, TX 77030. Electronic address: melopez@texaschildrens.org.
authors.forename: Monica E
authors.initials: ME
authors.lastname: Lopez
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000191:economics; D001064:Appendicitis / Q000191:economics* / Q000601:surgery; D002648:Child; D017046:Cost Savings / Q000379:methods* / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000191:economics* / Q000379:methods / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D013781:Texas; D013997:Time Factors
keywords: Appendicitis; Cost analysis; Process improvement; Quality improvement; Time-driven activity-based costing; Value