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. 2022 Jul;75(7):585-594.
doi: 10.1016/j.rec.2021.08.009. Epub 2021 Oct 20.

The Clinical outcomes, healthcare resource utilization, and related costs (COHERENT) model. Application in heart failure patients

[Article in English, Spanish]
Héctor Bueno  1 , José L Bernal  2 , Víctor Jiménez-Jiménez  3 , Francisco Javier Martín-Sánchez  4 , Xavier Rossello  5 , Guillermo Moreno  6 , Clara Goñi  7 , Víctor Gil  8 , Pere Llorens  9 , Nerea Naranjo  10 , Javier Jacob  11 , Pablo Herrero-Puente  12 , Sergio Garrote  13 , Juan Carlos Silla-Castro  14 , Stuart J Pocock  15 , Òscar Miró  8 ; ICA-SEMES ad hoc COHERENT study group
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The Clinical outcomes, healthcare resource utilization, and related costs (COHERENT) model. Application in heart failure patients

[Article in English, Spanish]
Héctor Bueno et al. Rev Esp Cardiol (Engl Ed). 2022 Jul.

Abstract

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.

Keywords: Acute heart failure; COHERENT model; Composite outcomes; Cost; Costes; Days alive out of hospital; Días de vida fuera del hospital; Emergency department; Graphical representation; Hospitalización; Hospitalization; Insuficiencia cardiaca aguda; Modelo COHERENT; Readmission; Reingresos; Representación gráfica; Resultados combinados; Salud basada en valor; Urgencias; Value-based health care.

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