Observational studyBMJ quality & safety2019
Bending the cost curve: time series analysis of a value transformation programme at an academic medical centre.
Observational study in BMJ quality & safety, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
7 citing papers in PubMed, 2 syntheses or guidelines pooled it, 18 citations in OpenAlex.
- A systematic review of the evidence of how hospitals capture financial benefits of process improvement and the impact on hospital financial performance.BMC health services research · 2023Pooled it
- Value-Based Healthcare Initiatives in Practice: A Systematic Review.Journal of healthcare management / American College of Healthcare Executives · 2021Pooled it
- Association between circadian rest-activity rhythm and meal timing: NHANES 2013-2014.Sleep health · 2026Article
- Global Adoption of Value-Based Health Care Initiatives Within Health Systems: A Scoping Review.JAMA health forum · 2025Article
- Improving Performance in Complex Surroundings: A Mixed Methods Evaluation of Two Hospital Strategies in the Netherlands.International journal of health policy and management · 2023Article
- Hospitals Bending the Cost Curve With Increased Quality: A Scoping Review Into Integrated Hospital Strategies.International journal of health policy and management · 2022Article
- The Financial and Clinical Impact of an Electronic Health Record Integrated Pathway in Elective Colon Surgery.Applied clinical informatics · 2020Article
Corrections and comments
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundReducing costs while increasing or maintaining quality is crucial to delivering high value care.
objectiveTo assess the impact of a hospital value-based management programme on cost and quality.
designTime series analysis of non-psychiatric, non-rehabilitation, non-newborn patients discharged between 1 September 2011 and 31 December 2017 from a US urban, academic medical centre.
interventionNYU Langone Health instituted an institution-wide programme in April 2014 to increase value of healthcare, defined as health outcomes achieved per dollar spent. Key features included joint clinical and operational leadership; granular and transparent cost accounting; dedicated project support staff; information technology support; and a departmental shared savings programme. MEASUREMENTS: Change in variable direct costs; secondary outcomes included changes in length of stay, readmission and in-hospital mortality.
resultsThe programme chartered 74 projects targeting opportunities in supply chain management (eg, surgical trays), operational efficiency (eg, discharge optimisation), care of outlier patients (eg, those at end of life) and resource utilisation (eg, blood management). The study cohort included 160 434 hospitalisations. Adjusted variable costs decreased 7.7% over the study period. Admissions with medical diagnosis related groups (DRG) declined an average 0.20% per month relative to baseline. Admissions with surgical DRGs had an early increase in costs of 2.7% followed by 0.37% decrease in costs per month. Mean expense per hospitalisation improved from 13% above median for teaching hospitals to 2% above median. Length of stay decreased by 0.25% per month relative to prior trends (95% CI -0.34 to 0.17): approximately half a day by the end of the study period. There were no significant changes in 30-day same-hospital readmission or in-hospital mortality. Estimated institutional savings after intervention costs were approximately $53.9 million. LIMITATIONS: Observational analysis.
conclusionA systematic programme to increase healthcare value by lowering the cost of care without compromising quality is achievable and sustainable over several years.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.