An eConsultant versus a hospital-based outpatient consultation for general (internal) medicine: a costing analysis

BMC Health Services Research

Research

Joshua Byrnes¹  Caroline Nicholson²  Jenny Job²  Maria Donald³  Claire Jackson⁴ 

[1] Centre for Applied Health Economics, Health Economics School of Medicine and Dentistry, Griffith University, Brisbane, Australia;UQ-MRI Centre for Health System Reform and Integration, The University of Queensland, Level 8, Health Sciences Building Royal Brisbane and Women’s Hospital Campus, 4029, Brisbane, QLD, Australia;UQ-MRI Centre for Health System Reform and Integration, The University of Queensland, Level 8, Health Sciences Building Royal Brisbane and Women’s Hospital Campus, 4029, Brisbane, QLD, Australia;General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia;UQ-MRI Centre for Health System Reform and Integration, The University of Queensland, Level 8, Health Sciences Building Royal Brisbane and Women’s Hospital Campus, 4029, Brisbane, QLD, Australia;General Practice and Primary Care Research, The University of Queensland, Brisbane, Australia;

关键词: eConsultant;    eConsult;    Outpatients;    Costing, efficiency;   

DOI  :  10.1186/s12913-023-09436-1

 received in 2023-02-21, accepted in 2023-04-23,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe eConsultant model of care is an outpatient substitution approach which has been evaluated and implemented extensively internationally. It provides an asynchronous, digital, clinician-to-clinician advice service, giving primary care physicians remote access to specialist support for patient care within 3 business days. Results from initial trials of the eConsultant model in Australia support international evidence of reduced wait times and improved access to specialist input, avoidance of face-to-face hospital outpatient visits, and better integrated care. This study compared the cost of delivery of an eConsultant episode of care with that of a hospital-based outpatient appointment.MethodsA cost-minimisation analysis, using a decision analytic model, was used to compare the two approaches. eConsultant costs were calculated from specialist reported data (minutes spent preparing the response; the number of patients referred subsequently for a hospital-based outpatient appointment) and administration staff data (time spent recording the occasion-of-service). Outpatient costs were calculated using finance data and information from outpatient clinic managers at the hospital-based outpatient clinic. The primary outcome was incremental cost saving per patient from a hospital system perspective. Uncertainty was explored using one-way sensitivity analyses and characterised with probabilistic sensitivity analysis using 10,000 Monte Carlo simulations.ResultsThe traditional referral pathway cost estimate was $587.20/consult compared to $226.13/consult for an eConsultant episode: an efficiency saving of $361.07 per patient. The incremental difference between eConsultant and traditional care was most sensitive to the cost estimate of an outpatient attendance, the time for a specialist to complete an eConsult, and the probability of a patient requiring a face-to-face hospital-based attendance following an eConsult. However, at the upper bounds of each of these estimates, an eConsult remained the most cost-efficient model. In 96.5% of the Monte Carlo simulations eConsult was found to be more cost efficient than the traditional approach.ConclusionsThe eConsultant model of care was associated with a 61.5% efficiency gain, allowing diversion of support to hospital-based outpatient appointments.

【 授权许可】

CC BY   
© The Author(s) 2023

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