Zimlichman Eyal, Keohane Carol, Franz Calvin, Everett Wendy L, Seger Diane L, Yoon Catherine, Leung Alexander A, Cadet Bismarck, Coffey Michael, Kaufman Nathan E, Bates David W
Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, USA.
Jt Comm J Qual Patient Saf. 2013 Jul;39(7):312-8. doi: 10.1016/s1553-7250(13)39044-8.
In-hospital adverse events are a major cause of morbidity and mortality and represent a major cost burden to health care systems. A study was conducted to evaluate the return on investment (ROI) for the adoption of vendor-developed computerized physician oder entry (CPOE) systems in four community hospitals in Massachusetts.
Of the four hospitals, two were under one management structure and implemented the same vendor-developed CPOE system (Hospital Group A), while the other two were under a second management structure and implemented another vendor-developed CPOE system (Hospital Group B). Cost savings were calculated on the basis of reduction in preventable adverse drug event (ADE) rates as measured previously. ROI, net cash flow, and the breakeven point during a 10-year cost-and-benefit model were calculated. At the time of the study, none of the participating hospitals had implemented more than a rudimentary decision support system together with CPOE.
Implementation costs were lower for Hospital Group A than B ($7,130,894 total or $83/admission versus $19,293,379 total or $113/admission, respectively), as were preventable ADE-related avoided costs ($7,937,651 and $16,557,056, respectively). A cost-benefit analysis demonstrated that Hospital Group A had an ROI of 11.3%, breaking even on the investment eight years following implementation. Hospital Group B showed a negative return, with an ROI of -3.1%.
Adoption of vendor CPOE systems in community hospitals was associated with a modest ROI at best when applying cost savings attributable to prevention of ADEs only. The modest financial returns can beattributed to the lack of clinical decision support tools.
医院内不良事件是发病和死亡的主要原因，也是医疗保健系统的主要成本负担。开展了一项研究，以评估马萨诸塞州四家社区医院采用供应商开发的计算机化医生医嘱录入（CPOE）系统的投资回报率（ROI）。
四家医院中，两家处于同一管理结构下，实施相同的供应商开发的CPOE系统（A组医院），另外两家处于另一种管理结构下，实施另一种供应商开发的CPOE系统（B组医院）。成本节约是根据之前测量的可预防药物不良事件（ADE）发生率的降低来计算的。计算了10年成本效益模型中的投资回报率、净现金流和盈亏平衡点。在研究时，参与研究的医院均未将超过基本的决策支持系统与CPOE一起实施。
A组医院的实施成本低于B组医院（分别为总计7130894美元或每次住院83美元，以及总计19293379美元或每次住院113美元），与可预防ADE相关的避免成本也是如此（分别为7937651美元和16557056美元）。成本效益分析表明，A组医院的投资回报率为11.3%，实施后八年投资实现收支平衡。B组医院的回报率为负，投资回报率为-3.1%。
在社区医院采用供应商CPOE系统时，仅应用因预防ADE而节省的成本，充其量只能带来适度的投资回报率。适度的财务回报可归因于缺乏临床决策支持工具。
