Leonard Kevin J, Dalziel Sandra
Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Ontario, Canada.
Healthc Manage Forum. 2011 Autumn;24(3):122-36. doi: 10.1016/j.hcmf.2011.07.006.
In this article, we elaborate on the cost-effectiveness of eHealth solutions and the need to evaluate the return on investment as is done routinely with all other major expenditures. To this end, we discuss the theory that exists today to explain some of the usage principles affiliated with information technology implementation in healthcare; namely, we reflect on the Technology Adoption Criteria in Health (TEACH) model and Wagner's Chronic Disease Management model. The basic premise of the TEACH model is that adoption requires work; this work must be recognized at the outset, and the progress to overcome the workload increase must be measured for the adoption to continue. Furthermore, both of these models have emphasized that the trade-off between cost and work and the benefits realized (as seen through measurement) must first be applied to patients that use the system frequently and on an ongoing basis (ie, the chronically ill). We refer to these ongoing users as consumers of healthcare resources-Consumers with Chronic Conditions (the 3C patients). In this article, we show that the benefits outweigh the costs only when we do, in fact, apply the analysis to 3C patients. Once an effective eHealth system has been developed for the 3C patients, then it can be straightforwardly extended to include all patients and other stakeholders.
在本文中，我们详细阐述了电子健康解决方案的成本效益，以及像对待所有其他重大支出一样，对投资回报率进行评估的必要性。为此，我们讨论了当今存在的理论，以解释与医疗保健领域信息技术实施相关的一些使用原则；具体而言，我们思考了健康领域技术采用标准（TEACH）模型和瓦格纳慢性病管理模型。TEACH模型的基本前提是采用需要付出努力；这项工作必须从一开始就得到认可，并且为了使采用持续下去，必须衡量克服工作量增加的进展情况。此外，这两个模型都强调，成本与工作以及所实现的效益（通过衡量来看）之间的权衡，必须首先应用于经常且持续使用该系统的患者（即慢性病患者）。我们将这些持续使用者称为医疗保健资源消费者——慢性病患者（3C患者）。在本文中，我们表明，只有当我们实际上将分析应用于3C患者时，效益才会超过成本。一旦为3C患者开发出有效的电子健康系统，那么就可以直接将其扩展到包括所有患者和其他利益相关者。
