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- Time-driven activity based costing (TDABC) in long-term healthcare (LTH)-A practical applicationPublication . Sargento, Ana; Santos, Isa; Carvalho, Henrique; Querido, AnaStatement of the Problem: This paper focuses the cost component of a larger ongoing action-research project (CARE4VALUE), aiming to enhance value creation (patient-centered health outcomes per unit of cost) in LTH providers. The main objective is to share the experience of designing and implementing TDABC in a Portuguese LTH unit. TDABC methodology applied to healthcare allows identifying the cost per patient, for each clinical condition, in the full cycle of care, mapping processes, activities, resources and time allocated. The cost model was developed in a close cooperation with the clinical and management staff of the partner LTH unit. Mixed qualitative and quantitative methods were applied, involving: Three focus groups and anonymized clinical data analysis to categorize different complexity degrees of patients; structured observation of the full cycle of care; analysis and rearrangement of accounting records and cost calculation per patient and activity. Despite the difficulties found, mainly concerning the adaptation of the existing management accounting system to the requirements of TDABC, the implementation in a real LTH setting proved successful. A recording tool and dashboard was also developed, to integrate multidimensional patient-centred information, prompting embeddedness of the model into daily practice.The cost model represents an important advance for the focus LTH unit, as it allows uncovering the cost per patient, according to his/her degree of complexity. Although applied to a specific LTH unit, it is replicable to similar units, generating valuable information for managers, policy-makers and funding.
- Defining clinical conditions in long-term healthcare as a first step to implement Time-Driven Activity Based Costing (TDABC)Publication . Querido, Ana; Sargento, Ana; Santos, Isa; Carvalho, Henrique; Reis, Catarina; Frederico, Manuela; Maximiano, Marisa; Oliveira, Sandra; Leal, SusanaBackground Increasing healthcare costs is a concern of all developed countries. In Long-Term Healthcare (LTH) this is reinforced by population ageing and corresponding prevalence of chronic diseases. Thus, it is fundamental to accurately measure costs and outcomes in healthcare, improving value created for patients, i.e., patientcentred health outcomes per monetary unit of cost [1, 2]. TDABC methodology applied to healthcare allows identifying the cost for each clinical condition in the full cycle of care, mapping processes, activities, resources and allocated time [3–5]. It has been mostly applied in acute-care settings, partly due to complexity of defining chronic condition [6]. Objective This paper focuses on the cost component of a larger on-going research project (CARE4VALUE), aiming to enhance value creation in LTH providers and applied to a partner LTH unit. Specifically, the main objective is to define clinical conditions in the context of LTH, as a first step in the implementation of TDBAC. Methods Mixed qualitative and quantitative methods were applied, including: 1) three focus groups conducted with the health team of the LTH unit (physician, nurses, physiotherapist, psychologist, social assistant) to select, discuss and validate the criteria to define clinical conditions; 2) construction of a composite indicator and testing it over a sample of anonymized clinical data from 21 patients; 3) structured observation of processes taken throughout the full cycle of care of patients in different conditions. Qualitative data was submitted to content analysis and validated among participants. Quantitative data used in the composite indicator, based on validated scales, was subject to normalization, aggregation and sensitivity analysis. Results One consensual outcome of the focus groups was that, in LTH, the disease or cause of entrance is less relevant to costs than the overall complexity of the patient, entailing psychical, social, spiritual and psychic-mental dimensions. Accordingly, a multidimensional classification model of patients in four complexity levels was delivered, after being validated and receiving consensus from the LTH team. Additionally, it will include a logging tool and dashboard to integrate separate patient-centred information and aid patient classification in complexity conditions. BMC Health Services Research 2018, 18(Suppl 2):684 Page 75 of 183 Conclusions The completion of this step allowed progressing in the design and implementation of the cost model, which, in turn, will support value measurement, and enhancing of the focus LTH unit. Besides, all involved professionals stated that their engagement in this phase of the project generated exceptional opportunities for interdisciplinary meetings and debate, contributing to closer ties between different areas of LTH.
- Apuramento de custos através do time-driven activity-based costing (TDABC) numa unidade de cuidados continuados e integrados com vista à criação de valorPublication . Santos, Isa Maria Marquês; Carvalho, Henrique AmadoEste projeto consiste em aplicar o Time-Driven Activity-Based Costing (TDABC) na Unidade de Cuidados Continuados Integrados (UCCI) da Batalha, com o objetivo de ser mais preciso no cálculo dos custos, para aumentar a criação de valor (resultados de saúde centrados no paciente por unidade de custo) da mesma. A metodologia TDABC aplicada à saúde permite identificar o custo por paciente, para cada condição clínica, no ciclo completo de cuidados (desde admissão até à alta), mapeando processos, atividades, recursos e tempo alocado. O modelo de custo foi desenvolvido em cooperação com os colaboradores da área clínica e de gestão da UCCI parceira. Aplicaram-se métodos qualitativos e quantitativos envolvendo: três focus group e análise de dados clínicos para categorizar os diferentes graus de complexidade dos pacientes; observação estruturada do ciclo completo de cuidados; análise e tratamento de registos contabilísticos e cálculo de custos por paciente e atividade. Apesar das dificuldades encontradas, principalmente no que diz respeito à adaptação do sistema de contabilidade de gestão existente aos requisitos do TDABC, a implementação num ambiente real na referida UCCI foi bem-sucedida. O modelo de custo representa um avanço importante para a UCCI, pois permite apurar o custo por paciente, de acordo com seu grau de complexidade. Embora aplicado a uma unidade específica de cuidados continuados, é possível replicar para unidades semelhantes, gerando informações valiosas para os gestores, legisladores e responsáveis pelo financiamento.