Deal Ken, Keshavjee Karim, Troyan Sue, Kyba Robert, Holbrook Anne Marie
DeGroote School of Business, McMaster University, 1280 Main St. West, Hamilton, ON, Canada L8S 4M4.
CEO, InfoClin Inc, 567 College St., Suite 201, Toronto, ON, Canada M6G 3W9.
Int J Med Inform. 2014 Jul;83(7):517-28. doi: 10.1016/j.ijmedinf.2014.04.007. Epub 2014 Apr 29.
Cardiovascular disease (CVD) is an important target for electronic decision support. We examined the potential sustainability of an electronic CVD management program using a discrete choice experiment (DCE). Our objective was to estimate physician and patient willingness-to-pay (WTP) for the current and enhanced programs.
Focus groups, expert input and literature searches decided the attributes to be evaluated for the physician and patient DCEs, which were carried out using a Web-based program. Hierarchical Bayes analysis estimated preference coefficients for each respondent and latent class analysis segmented each sample. Simulations were used to estimate WTP for each of the attributes individually and for an enhanced vascular management system.
144 participants (70 physicians, 74 patients) completed the DCE. Overall, access speed to updated records and monthly payments for a nurse coordinator were the main determinants of physician choices. Two distinctly different segments of physicians were identified - one very sensitive to monthly subscription fee and speed of updating the tracker with new patient data and the other very sensitive to the monthly cost of the nurse coordinator and government billing incentives. Patient choices were most significantly influenced by the yearly subscription cost. The estimated physician WTP was slightly above the estimated threshold for sustainability while the patient WTP was below.
Current willingness to pay for electronic cardiovascular disease management should encourage innovation to provide economies of scale in program development, delivery and maintenance to meet sustainability thresholds.
心血管疾病（CVD）是电子决策支持的重要目标。我们使用离散选择实验（DCE）研究了电子CVD管理项目的潜在可持续性。我们的目标是估计医生和患者对当前及强化项目的支付意愿（WTP）。
焦点小组、专家意见和文献检索确定了用于医生和患者DCE评估的属性，这些评估通过基于网络的程序进行。分层贝叶斯分析估计了每个受访者的偏好系数，潜在类别分析对每个样本进行了细分。模拟用于分别估计每个属性以及强化血管管理系统的WTP。
144名参与者（70名医生，74名患者）完成了DCE。总体而言，获取更新记录的速度和护士协调员的月费用是医生选择的主要决定因素。识别出两类明显不同的医生群体——一类对月订阅费和用新患者数据更新追踪器的速度非常敏感，另一类对护士协调员的月费用和政府计费激励非常敏感。患者的选择受年度订阅成本影响最大。估计的医生WTP略高于可持续性估计阈值，而患者WTP低于该阈值。
当前对电子心血管疾病管理的支付意愿应鼓励创新，以便在项目开发、交付和维护方面实现规模经济，从而达到可持续性阈值。
