The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

THERAPIST DRIVEN PROTOCOLS (TDP) - COST BENEFITS AND OUTCOME EQUIVALENCY

Andrew Egol DO, William Joyce RRT, Lisa Colsky RRT, I. Alan Fein MD, Richard Prager MD. Baptist Hospital of Miami, Respiratory Care Services, Miami, FL.

Introduction: TDP has been advocated as a methodology of improving distribution of respiratory therapy by empowering therapists to work within a protocol environment thereby achieving efficiency by minimizing variation in ordering practices. In order for a TDP program to be effective, it must have outcomes at least equal to those prior to the institution of TDP. In addition, demonstrating cost benefit while maintaining equivalent outcomes would be ideal. The purpose of this study was to examine whether such a cost benefit exists.

Methods - A full service TDP program was begun at a 513 bed acute care tertiary community hospital in March, 1995. The TDP program functions as a consultative service with both modality specific and symptom specific protocols. Nine months after beginning the TDP program, records from 90 patients participating in the TDP service were randomly selected. In addition, 89 patients in the same period of time who were receiving respiratory therapy but not participating in the TDP program were randomly selected and served as the control group. Demographics such as age, length of stay (overall hospital and ICU) were compared to determine group equivalency. Billing information was obtained through the hospital's financial database. Financial variables extracted included: Gross billing (total hospital charges), Percent of Gross billing (percent of gross billing attributed to all respiratory care) and Daily protocol charges (daily charges related to items only covered by protocol use). All of the above variables were abstracted and entered into a relational database for analysis. Statistical analysis was then performed by SPSS 7.0. Independent t-test analysis was used to analyze all variables.

Results: There were no differences between the groups in age, or length of stay. These were differences between ICU length of stay (TDP > Non-TDP). These differences (without changes in overall length of stay) likely explains the differences in gross billing between the TDP and Non-TDP groups (TDP - $47,911, Non-TDP - $34,059, p < 0.018). All respiratory care as a percent of gross billing was lower in the TDP group (7.52% - TDP, 14.20% - Non-TDP, p < 0.0005). There was a difference of $116/day between the TDP and Non-TDP daily protocol charges ($195/day - TDP, $311/day - Non-TDP, p < 0.0005).

Conclusions: There is significant decrease in protocol charges between the two groups of $116/day. When extrapolated over the length of stay of 13 days this calculates to a savings of $1508/patient. If 45 new TDP patients are seen/month, this represents a savings of $814,320/year. When the increased TDP costs are factored in, the net savings is equal to $682,960. However, the 45 new patients/months that are seen represents only a 6.5% penetration into the 688 new respiratory patients/month. If there were a TDP penetration of 100%, this savings in respiratory care would increase to over $12,450,048 with a net savings (after an increase of TDP expenses of $2,008,348) of $10,441,700. Based on this data, it appears that TDP is cost-beneficial without negatively impacting outcome. A larger prospective randomized trial would be beneficial to determine if this TDP cost advantage persists with outcome equivalency.

Reference: OF-96-087

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