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Defining clinical conditions in long-term healthcare as a first step to implement Time-Driven Activity Based Costing (TDABC)

2018-09-13Conference object Open access
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dc.contributor.authorQuerido, Ana
dc.contributor.authorSargento, Ana
dc.contributor.authorSantos, Isa
dc.contributor.authorCarvalho, Henrique
dc.contributor.authorReis, Catarina
dc.contributor.authorFrederico, Manuela
dc.contributor.authorMaximiano, Marisa
dc.contributor.authorOliveira, Sandra
dc.contributor.authorLeal, Susana
dc.date.accessioned2019-05-13T08:08:12Z
dc.date.available2019-05-13T08:08:12Z
dc.date.issued2018-09-13
dc.descriptionCare4Value GRANT_NUMBER: POCI-01-0145-FEDER-23248
dc.description.abstractBackground 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.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.doi0.1186/s12913-018-3444-8pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.8/3944
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.relationPOCI-01-0145-FEDER-023248pt_PT
dc.relation.ispartofseries18;
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/pt_PT
dc.subjectLong-term Health Carept_PT
dc.subjectTime-Driven Activity Based Costing (TDABC),pt_PT
dc.subjectClinical conditionspt_PT
dc.subjectPatient Centered Datapt_PT
dc.subjectPatient complexitypt_PT
dc.titleDefining clinical conditions in long-term healthcare as a first step to implement Time-Driven Activity Based Costing (TDABC)pt_PT
dc.typeconference object
dspace.entity.typePublication
oaire.citation.conferencePlaceLeiria, Portugalpt_PT
oaire.citation.issueSuppl 2pt_PT
oaire.citation.startPage75pt_PT
oaire.citation.titleBMC Health Services Researchpt_PT
oaire.citation.volume684pt_PT
person.familyNameQuerido
person.familyNameMARTO SARGENTO
person.familyNameMarquês Santos
person.familyNameAmado Carvalho
person.familyNameFERREIRA VIVEIROS TAVARES DOS REIS
person.familyNameMaximiano
person.givenNameAna
person.givenNameANA LÚCIA
person.givenNameIsa Maria
person.givenNameHenrique
person.givenNameCATARINA ISABEL
person.givenNameMarisa
person.identifier.ciencia-idE311-0BBA-444F
person.identifier.ciencia-id9019-96CB-5980
person.identifier.ciencia-id6D15-1056-679D
person.identifier.ciencia-idEF1B-E7A3-4252
person.identifier.ciencia-idA919-B117-A16D
person.identifier.orcid0000-0002-5021-773X
person.identifier.orcid0000-0001-5716-1890
person.identifier.orcid0000-0002-0014-8799
person.identifier.orcid0000-0002-1984-5092
person.identifier.orcid0000-0003-1529-629X
person.identifier.orcid0000-0002-1212-7864
person.identifier.scopus-author-id26767664900
rcaap.rightsopenAccesspt_PT
rcaap.typeconferenceObjectpt_PT
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relation.isAuthorOfPublicationaedc92c3-898e-4d98-8a54-bf78e27201e8
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relation.isAuthorOfPublicationccf98646-460f-466b-9728-2394fa6e744b
relation.isAuthorOfPublication18092229-fa61-402b-978c-56b8127d46e9
relation.isAuthorOfPublication.latestForDiscovery51328dd6-b900-4ffa-adf1-f7ee0262648c

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