Article Text
PDF
Abstract
Objective To complete an economic evaluation within a randomised controlled trial (RCT) comparing the use of an electronic discharge communication tool (eDCT) compared with usual care.
Setting Patients being discharged from a single tertiary care centre’s internal medicine Medical Teaching Units.
Participants Between January 2012 and December 2013, 1399 patients were randomised to a discharge mechanism. Forty-five patients were excluded from the economic evaluation as they did not have data for the index hospitalisation cost; 1354 patients contributed to the economic evaluation.
Intervention eDCT generated at discharge containing structured content on reason for admission, details of the hospital stay, treatments received and follow-up care required. The control group was discharged via traditional dictation methods.
Primary and secondary outcome measures The primary economic outcome was the cost per quality-adjusted life year (QALY) gained. Secondary outcomes included the cost per death avoided and the cost per readmission avoided.
Results The average transcription cost was $C22.28 per patient, whereas the estimated cost of the eDCT was $C13.33 per patient. The cost per QALY gained was $C239 933 in the eDCT arm compared with usual care due to the very small gains in effectiveness and approximately $C800difference in resource utilisation costs. The bootstrap analyses resulted in eDCT being more effective and more costly in 29.2% of samples, less costly and more effective in 29.2% of samples, less effective and more costly in 23.9% of samples and finally, less costly and less effective in 17.7% of samples.
Conclusions The eDCT reduced per patient costs of the generation of discharge summaries. The bootstrap estimates demonstrate considerable uncertainty supporting the finding of neutrality reported in the clinical component of the RCT. The immediate transcription cost savings and previously documented provider and patient satisfaction may increase the impetus for organisations to invest in such systems, provided they have a foundation of eHealth infrastructure and readiness.
Trial registration number NCT01402609.
- health economics
- health policy
- organisational development
- organisation of health services
- quality in health care
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Statistics from Altmetric.com
Footnotes
Contributors LKS, M-JS, WAG and FC contributed to the conceptualisation of the study. M-JS and WAG led all aspects of the primary clinical analysis of the randomised controlled trial (RCT). FC provided oversight and supervision of the economic analysis of the RCT. LKS completed the analysis with supervision from FC, M-JS and WAG. LKS drafted the manuscript with FC, M-JS and WAG providing critical revisions. All authors approved the final version.
Funding This RCT was funded by the Canadian Institutes of Health Research (CIHR) and was further supported by the Medical Teaching Unit (supporting implementation of eDCT) Alberta Health Services (adoption and implementation) and W21C (development and research).
Competing interests None declared.
Patient consent Obtained.
Ethics approval Conjoint Health Research Ethics Board at the University of Calgary (no 23469).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Any unpublished aggregate data will be made available upon request by the corresponding author.