A pilot study assessing clinic value in pediatric pharyngeal dysphagia: The OPPS/cost method
Steven Coppess JD, MBA  Jennifer Soares MD  Bianca K. Frogner PhD  Kimberley DeMarre MS, CCC‐SLP  Amy Faherty MS, CCC‐SLP  Jennifer Hoang AAS  Mahek Shah MD … See all authors
First published: 04 October 2018 https://doi.org/10.1002/lary.27552
Presented as a podium presentation at the American Broncho‐Esophagological Association Annual Spring Meeting, National Harbor, Maryland, U.S.A., April 19, 2018. This article was accepted for the Seymour Cohen Award at the 2018 American Broncho‐Esophagological Association Annual Spring Meeting.
Funding for the electronic survey collection was provided by the Sie‐Hatsukami Foundation.
The authors have no other funding, financial relationships, or conflicts of interest to disclose.
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Abstract
Objectives/Hypothesis
Given the costs of healthcare, capitation, and desires for quality improvement (QI), there is a need to better assess healthcare value. Time‐driven activity‐based costing and the Quadruple Aim have evaluated value by assessing health outcomes and provider experiences relative to costs. The proposed OPPS/Cost method expands on this to examine value for aerodigestive clinic treatment of pediatric persistent pharyngeal dysphagia: O + P1 + P2 + S/Cost (O = objective health [video‐fluoroscopic swallow study results], P1 = patient/family experience [Consumer Assessment of Healthcare Providers and Systems], P2 = provider experience [Copenhagen Burnout Inventory {CBI}], S = subjective health [Feeding/Swallowing‐Impact Survey], C = cost [time‐driven activity‐based costing]).

Study Design
Use of QI time data, surveys, and retrospective chart review for 56 patient encounters.

Methods
Staff interviews were used to develop process maps, and monetary values were assigned to activities. OPPS/Cost outcomes were normalized amongst variables, and composite values were calculated. Comparisons were made using a Student t test for pre‐ and postclinic relocation over a 14‐month period.

Results
Time reductions were check‐in (13 minutes/patient), rooming (21 minutes/patient), and providers (4 minutes/patient). Patient in‐room wait time increased (4 minutes/patient). The CBI identified burnout as an area for improvement. OPPS/Cost composite values increased by 14%, with a 1.7% cost reduction, improvement in objective and subjective health outcomes of 47.4% (P < .05) and 7.3%, respectively, and stable patient/family experience.

Conclusions
OPPS/Cost is feasible in an interdisciplinary clinic and helped evaluate value during a clinic relocation. The QI opportunities identified are indicative of the potential of OPPS/Cost.

Level of Evidence
NA

Laryngoscope, 129:1527–1532, 2019