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An innovative collaboration between UCD Michael Smurfit Graduate Business School, Children's Health Ireland at Temple Street, NUI Maynooth, Harvard Business School and Boston Children's Hospital has led to a new study recently published in NEJM Catalyst.

‘Innovations in Evaluating Ambulatory Costs of Cystic Fibrosis Care: A Comparative Study Across Multidisciplinary Care Centers in Ireland and the United States’ explores the cost of outpatient cystic fibrosis (CF) care for children across Ireland and the United States using a combination of time-driven activity-based costing (TDABC) together with variance analysis.

The study offers new insights and ways to compare the process of care and associated costs across similar healthcare delivery operations for the care of children with CF.

Read the full paper here. 

Key Findings

CF clinic visit costs vary significantly between sites, with the largest variance in the 6–17 age group.

Physicians were found to be the most expensive professionals in the care process in both sites. In the US, physicians and dietitians spent the most time with patients, whilst Clinical Nurse Specialists and dietitians did so in Ireland.

The amount of time spent with patients had a significant effect on cost, more time was spent with patients in Ireland than the US. Different types of clinicians providing care was also a factor, as the US had a different mix of and higher-cost providers. Furthermore, clinicians were also paid 31% more in the US than in Ireland.

TDABC provided granular cost insights, allowing the researchers to pinpoint efficiency opportunities without compromising the quality of care.

Skill mix and care structure differences impact costs, highlighting opportunities to optimise resource allocation.

Why This Matters

With rising healthcare costs within a new era of pharmacotherapy innovations, which are resulting in improved quality of life and improved survival rates, understanding how multidisciplinary care models impact efficiency and expenditure is crucial. The study demonstrates how process mapping and variance analysis can inform value-based healthcare decisions.

The interdisciplinary and trans-Atlantic team include:

Professor Robert Kaplan

Senior Fellow and Marvin Bower Professor of Leadership Development, Emeritus, Harvard Business School, Boston, Massachusetts, USA

Professor Gerardine Doyle

Full Professor of Accounting, UCD Michael Smurfit Graduate Business School, University College Dublin, Dublin, Ireland

UCD Geary Institute for Public Policy, University College Dublin, Dublin, Ireland

Emma Brady

Senior Pharmacist, Children’s Health Ireland, Dublin, Ireland

PhD Student, UCD Michael Smurfit Graduate Business School, Blackrock, Ireland

Professor Gregory Sawicki

Director, Cystic Fibrosis Center, Boston Children’s Hospital, Boston, Massachusetts, USA

Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA

Associate Professor of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA

Dr Ryan Perkins

Director, Cystic Fibrosis Center, Boston Children’s Hospital, Boston, Massachusetts, USA

Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA

Associate Professor of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA

Dr Kate Cullen

Assistant Professor of Accounting, School of Business, Maynooth University, Maynooth, Ireland