Article Text
Abstract
Background The transition between acute care and community care can be a vulnerable period in a patients’ treatment due to the potential for postdischarge adverse events. The vulnerability of this period has been attributed to factors related to the miscommunication between hospital-based and community-based physicians. Electronic discharge communication has been proposed as one solution to bridge this communication gap. Prior to widespread implementation of these tools, the costs and benefits should be considered.
Objective To establish the cost and cost-effectiveness of electronic discharge communications compared with traditional discharge systems for individuals who have completed care with one provider and are transitioning care to a new provider.
Methods We conducted a systematic review of the published literature, using best practices, to identify economic evaluations/cost analyses of electronic discharge communication tools. Inclusion criteria were: (1) economic analysis and (2) electronic discharge communication tool as the intervention. Quality of each article was assessed, and data were summarised using a component-based analysis.
Results One thousand unique abstracts were identified, and 57 full-text articles were assessed for eligibility. Four studies met final inclusion criteria. These studies varied in their primary objectives, methodology, costs reported and outcomes. All of the studies were of low to good quality. Three of the studies reported a cost-effectiveness measure ranging from an incremental daily cost of decreasing average discharge note completion by 1 day of $0.331 (2003 Canadian), a cost per page per discharge letter of €9.51 and a dynamic net present value of €31.1 million for a 5-year implementation of the intervention. None of the identified studies considered clinically meaningful patient or quality outcomes.
Discussion Economic analyses of electronic discharge communications are scarcely reported, and with inconsistent methodology and outcomes. Further studies are needed to understand the cost-effectiveness and value for patient care.
- Systematic review
- Economic evaluation
- Cost-analysis
- Discharge
- eHealth
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Footnotes
Contributors Design of the study (LKS, RE, KT, DLL, PR, MJ and FC); collection of data (LKS and RE); management of data (LKS and RE); analysis of data (LKS, RE and FC); interpretation of the data (LKS, RE, KT and FC); preparation of manuscript (LKS, RE, KT and FC); review of manuscript (LKS, RE, KT, PR, MJ, MS, WAG and FC); approval of manuscript (LKS, RE, KT, PR, MJ, MS, WAG and FC).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement This systematic review did not include any primary research, and there is no additional unpublished data associated with this study. All data are publicly available in published literature, cited within the main document. A full search strategy is attached in the supplemental file.