Quality Cost Indicator model at the IPU Breast Clinic Franciscus

A lot of research is going into the calculation of value, however at this moment the healthcare industry lacks a model for monitoring value in terms of outcomes and costs in daily practice. Therefore many healthcare providers monitor costs and outcomes separately. Nevertheless, our team believes that a model combining outcomes and costs can help healthcare providers control rising costs while maintaining high level outcomes. Therefore we created the QCI model.

This model is based on five concepts: Textbook Outcome (TO), Resulting Outcome (RO), average total costs, QCI date, and QCI period.

TO is accomplished when patients meet all health outcome indicators, including survival, as defined for a specific medical condition. RO is the number of patients who achieve TO divided by the total number of patients. Average total costs are calculated by summing the costs of primary treatment and any related expenses and dividing these costs by the number of patients receiving the treatment. The QCI date is the date when a specific procedure, such as surgery, takes place and the RO and average total costs parameters are attributed to it. The QCI period is a fixed follow-up period used to determine RO and total costs, considering all costs from the start of the care process to the end of the QCI period.

QCI is calculated as follows: QCI = RO * 100 / Average total costs (per thousand Euro’s)

Currently, the following health outcomes (based on the ICHOM set) are used to determine if textbook outcome is achieved: re-operation due to positive margins, re-operation due to bleeding/infection, survival, febrile neutropenia (currently being added), and EORTC domain scales such as quality of life or satisfaction with the breast area (currently being added). Using flow tables with patients and physicians the IPU Breast Clinic determines which new outcomes to include in the model.

For practical purposes, the costs are not calculated for the full cycle of care but rather for a shorter time frame, in this case one year, which can be extended or shortened. Also, not all cost data is available, such as the cost of general practitioners visits, so these costs cannot be incorporated into the calculation. We do however believe that practicality is also our strongest point. We are using the model in a PDCA cycle and are making improvements in terms of costs and outcomes as we speak. Alongside this we are still doing research into improving the models’ sensitivity to value.

Finally we invite you to take a look at the dashboard we use to present the results, which is shown in the screenshots below.