Sevick Laura K, Esmail Rosmin, Tang Karen, Lorenzetti Diane L, Ronksley Paul, James Matthew, Santana Maria, Ghali William A, Clement Fiona
The Department Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Department of Health Technology Assessment and Adoption, Alberta Health Services, Calgary, Alberta, Canada.
BMJ Open. 2017 Jul 2;7(6):e014722. doi: 10.1136/bmjopen-2016-014722.
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.
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.
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.
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.
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.
由于出院后不良事件的潜在风险，急性护理与社区护理之间的过渡阶段可能是患者治疗过程中的脆弱时期。这一时期的脆弱性归因于医院医生与社区医生之间沟通不畅的相关因素。电子出院沟通被提议作为弥合这一沟通差距的一种解决方案。在广泛应用这些工具之前，应考虑其成本和效益。
对于已在一个医疗机构完成治疗并将护理过渡到新医疗机构的个体，确定电子出院沟通与传统出院系统相比的成本及成本效益。
我们采用最佳实践方法对已发表的文献进行系统综述，以确定电子出院沟通工具的经济评估/成本分析。纳入标准为：（1）经济分析；（2）以电子出院沟通工具作为干预措施。评估每篇文章的质量，并使用基于成分的分析方法汇总数据。
共识别出1000篇独特的摘要，对57篇全文进行了资格评估。四项研究符合最终纳入标准。这些研究在主要目标、方法、报告的成本和结果方面各不相同。所有研究质量均为低到中等。其中三项研究报告了成本效益指标，范围从平均出院记录完成时间每减少1天增量每日成本为0.331加元（2003年加拿大货币）、每份出院信件每页成本为9.51欧元，到干预措施实施5年的动态净现值为3110万欧元。所有已识别的研究均未考虑具有临床意义的患者或质量结果。
电子出院沟通的经济分析报道极少，且方法和结果不一致。需要进一步研究以了解其成本效益及对患者护理的价值。
