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Publications
Publications
  • March 2016
  • Article
  • Journal of Oncology Practice

Using Quality Improvement Methods and Time-Driven Activity-Based Costing to Improve Value-Based Cancer Care Delivery at a Cancer Genetics Clinic

By: R.Y. Tan, M. Met-Domestici, K. Zhou, A.B. Guzman, S.T. Lim, K.C. Soo, T.W. Feeley and J. Ngeow
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Abstract

Purpose:
To meet increasing demand for cancer genetic testing and improve value-based cancer care delivery, National Cancer Centre Singapore restructured the Cancer Genetics Service in 2014. Care delivery processes were redesigned. We sought to improve access by increasing the clinic capacity of the Cancer Genetics Service by 100% within 1 year without increasing direct personnel costs.
Methods:
Process mapping and plan-do-study-act (PDSA) cycles were used in a quality improvement project for the Cancer Genetics Service clinic. The impact of interventions was evaluated by tracking the weekly number of patient consultations and access times for appointments between April 2014 and May 2015. The cost impact of implemented process changes was calculated using the time-driven activity-based costing method.
Results:
Our study completed two PDSA cycles. An important outcome was achieved after the first cycle: The inclusion of a genetic counselor increased clinic capacity by 350%. The number of patients seen per week increased from two in April 2014 (range, zero to four patients) to seven in November 2014 (range, four to 10 patients). Our second PDSA cycle showed that manual preappointment reminder calls reduced the variation in the nonattendance rate and contributed to a further increase in patients seen per week to 10 in May 2015 (range, seven to 13 patients). There was a concomitant decrease in costs of the patient care cycle by 18% after both PDSA cycles.
Conclusion:
This study shows how quality improvement methods can be combined with time-driven activity-based costing to increase value. In this paper, we demonstrate how we improved access while reducing costs of care delivery.

Keywords

Cancer Treatment; Value Based Health Care; Time-Driven Activity-Based Costing; Health Care and Treatment; Quality; Performance Improvement; Activity Based Costing and Management

Citation

Tan, R.Y., M. Met-Domestici, K. Zhou, A.B. Guzman, S.T. Lim, K.C. Soo, T.W. Feeley, and J. Ngeow. "Using Quality Improvement Methods and Time-Driven Activity-Based Costing to Improve Value-Based Cancer Care Delivery at a Cancer Genetics Clinic." Journal of Oncology Practice 12, no. 3 (March 2016): 320–331. (e-Pub 1/2016. PMID: 26759493.)
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More from the Authors

    • November 2021
    • Urology

    Determining Variable Costs in the Acute Urolithiasis Cycle of Care Through Time-driven Activity-based Costing

    By: Tyler R. McClintock, David F. Friedlander, Aiden Y. Feng, Mahek A. Shah, Daniel J. Pallin, Steven L. Chang, Angela M. Bader, Thomas W. Feeley, Robert S. Kaplan and George E. Haleblian
    • June 2021
    • Journal of Surgical Research

    Developing a Value Framework: Utilizing Administrative Data to Assess an Enhanced Care Initiative

    By: Casey J. Allen, Jarrod S. Eska, Nikhil G. Thaker, Thomas W. Feeley, Robert S. Kaplan, Ryan W. Huey, Ching-Wei D. Tzeng, Jeffrey E. Lee, Steven J. Frank, Thomas A. Aloia, Vijaya Gottumukkala and Matthew H.G. Katz
    • May 2021
    • European Urology

    Value-Based Healthcare in Urology: A Collaborative Review

    By: Chanan Reitblat, Paul A. Bain, Michael E. Porter, David N. Bernstein, Thomas W. Feeley, Markus Graefen, Santosh Iyer, Matthew J. Resnick, C.J. Stimson, Quoc-Dien Trinh and Boris Gershman
More from the Authors
  • Determining Variable Costs in the Acute Urolithiasis Cycle of Care Through Time-driven Activity-based Costing By: Tyler R. McClintock, David F. Friedlander, Aiden Y. Feng, Mahek A. Shah, Daniel J. Pallin, Steven L. Chang, Angela M. Bader, Thomas W. Feeley, Robert S. Kaplan and George E. Haleblian
  • Developing a Value Framework: Utilizing Administrative Data to Assess an Enhanced Care Initiative By: Casey J. Allen, Jarrod S. Eska, Nikhil G. Thaker, Thomas W. Feeley, Robert S. Kaplan, Ryan W. Huey, Ching-Wei D. Tzeng, Jeffrey E. Lee, Steven J. Frank, Thomas A. Aloia, Vijaya Gottumukkala and Matthew H.G. Katz
  • Value-Based Healthcare in Urology: A Collaborative Review By: Chanan Reitblat, Paul A. Bain, Michael E. Porter, David N. Bernstein, Thomas W. Feeley, Markus Graefen, Santosh Iyer, Matthew J. Resnick, C.J. Stimson, Quoc-Dien Trinh and Boris Gershman
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