The Clinical outcomes, healthcare resource utilization, and related costs (COHERENT) model. Application in heart failure patients.
Por:
Bueno H, Bernal JL, Jiménez-Jiménez V, Martín-Sánchez FJ, Rossello X, Moreno G, Goñi C, Gil V, Llorens P, Naranjo N, Jacob J, Herrero-Puente P, Garrote S, Silla-Castro JC, Pocock SJ and Miró Ò
Publicada:
1 jul 2022
Ahead of Print:
20 oct 2021
Resumen:
INTRODUCTION AND OBJECTIVES: Composite endpoints are widely used but have several limitations. The Clinical Outcomes, HEalthcare REsource utilizatioN and relaTed costs (COHERENT) model is a new approach for visually displaying and comparing composite endpoints including all their components (incidence, timing, duration) and related costs. We aimed to assess the validity of the COHERENT model in a patient cohort. METHODS: A color graphic system displaying the percentage of patients in each clinical situation (vital status and location: at home, emergency department [ED] or hospital) and related costs at each time point during follow-up was created based on a list of mutually exclusive clinical situations coded in a hierarchical fashion. The system was tested in a cohort of 1126 patients with acute heart failure from 25 hospitals. The system calculated and displayed the time spent in each clinical situation and health care resource utilization-related costs over 30 days. RESULTS: The model illustrated the times spent over 30 days (2.12% in ED, 23.6% in index hospitalization, 2.7% in readmissions, 65.5% alive at home, and 6.02% dead), showing significant differences between patient groups, hospitals, and health care systems. The tool calculated and displayed the daily and cumulative health care-related costs over time (total, €4 895 070; mean, €144.91 per patient/d). CONCLUSIONS: The COHERENT model is a new, easy-to-interpret, visual display of composite endpoints, enabling comparisons between patient groups and cohorts, including related costs. The model may constitute a useful new approach for clinical trials or observational studies, and a tool for benchmarking, and value-based health care implementation.
Filiaciones:
Bueno H:
Grupo de Investigación Cardiovascular Multidisciplinaria Traslacional, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
Facultad de Medicina, Universidad Complutense, Madrid, Spain
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
Bernal JL:
Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
Jiménez-Jiménez V:
Laboratorio de Mecanoadaptación y Biología de Caveolas, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
Martín-Sánchez FJ:
Grupo de Investigación Cardiovascular Multidisciplinaria Traslacional, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
Facultad de Medicina, Universidad Complutense, Madrid, Spain
Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
Rossello X:
Grupo de Investigación Cardiovascular Multidisciplinaria Traslacional, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
Servei de Cardiologia, Institut d'Investigació Sanitària Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
Moreno G:
Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
Facultad de Medicina, Universidad Complutense, Madrid, Spain
Goñi C:
Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
Gil V:
Servei d'Urgències, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
:
Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Alicante, Spain
Naranjo N:
Facultad de Ingeniería Biomédica, Universidad Politécnica de Madrid, Madrid, Spain
Jacob J:
Servei d'Urgències, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
Herrero-Puente P:
Servicio de Urgencias, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
Garrote S:
Grupo de Investigación Cardiovascular Multidisciplinaria Traslacional, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
Silla-Castro JC:
Unidad de Bioinformática, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
Pocock SJ:
Grupo de Investigación Cardiovascular Multidisciplinaria Traslacional, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
Miró Ò:
Servei d'Urgències, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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