电子临床决策支持系统对提高坦桑尼亚农村地区产前和分娩护理质量的成本效益：一项干预性研究。
Cost-effectiveness of an electronic clinical decision support system for improving quality of antenatal and childbirth care in rural Tanzania: an intervention study.
作者信息
Saronga Happiness Pius, Duysburgh Els, Massawe Siriel, Dalaba Maxwell Ayindenaba, Wangwe Peter, Sukums Felix, Leshabari Melkizedeck, Blank Antje, Sauerborn Rainer, Loukanova Svetla
机构信息
Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
出版信息
BMC Health Serv Res. 2017 Aug 7;17(1):537. doi: 10.1186/s12913-017-2457-z.
BACKGROUND
QUALMAT project aimed at improving quality of maternal and newborn care in selected health care facilities in three African countries. An electronic clinical decision support system was implemented to support providers comply with established standards in antenatal and childbirth care. Given that health care resources are limited and interventions differ in their potential impact on health and costs (efficiency), this study aimed at assessing cost-effectiveness of the system in Tanzania.
METHODS
This was a quantitative pre- and post- intervention study involving 6 health centres in rural Tanzania. Cost information was collected from health provider's perspective. Outcome information was collected through observation of the process of maternal care. Incremental cost-effectiveness ratios for antenatal and childbirth care were calculated with testing of four models where the system was compared to the conventional paper-based approach to care. One-way sensitivity analysis was conducted to determine whether changes in process quality score and cost would impact on cost-effectiveness ratios.
RESULTS
Economic cost of implementation was 167,318 USD, equivalent to 27,886 USD per health center and 43 USD per contact. The system improved antenatal process quality by 4.5% and childbirth care process quality by 23.3% however these improvements were not statistically significant. Base-case incremental cost-effectiveness ratios of the system were 2469 USD and 338 USD per 1% change in process quality for antenatal and childbirth care respectively. Cost-effectiveness of the system was sensitive to assumptions made on costs and outcomes.
CONCLUSIONS
Although the system managed to marginally improve individual process quality variables, it did not have significant improvement effect on the overall process quality of care in the short-term. A longer duration of usage of the electronic clinical decision support system and retention of staff are critical to the efficiency of the system and can reduce the invested resources. Realization of gains from the system requires effective implementation and an enabling healthcare system.
TRIAL REGISTRATION
Registered clinical trial at www.clinicaltrials.gov ( NCT01409824 ). Registered May 2009.
背景
QUALMAT项目旨在提高三个非洲国家选定医疗机构的孕产妇和新生儿护理质量。实施了一个电子临床决策支持系统，以支持医护人员遵守产前和分娩护理的既定标准。鉴于医疗资源有限，且不同干预措施对健康和成本（效率）的潜在影响各异，本研究旨在评估该系统在坦桑尼亚的成本效益。
方法
这是一项干预前后的定量研究，涉及坦桑尼亚农村地区的6个卫生中心。成本信息从医护人员的角度收集。结果信息通过观察孕产妇护理过程收集。计算产前和分娩护理的增量成本效益比，并对该系统与传统纸质护理方法进行比较的四种模型进行测试。进行单向敏感性分析，以确定过程质量得分和成本的变化是否会影响成本效益比。
结果
实施的经济成本为167,318美元，相当于每个卫生中心27,886美元，每次接触43美元。该系统使产前过程质量提高了4.5%，分娩护理过程质量提高了23.3%，但这些提高在统计学上并不显著。该系统的基础案例增量成本效益比分别为每1%的产前和分娩护理过程质量变化2469美元和338美元。该系统的成本效益对成本和结果的假设敏感。
结论
尽管该系统设法略微改善了各个过程质量变量，但在短期内对整体护理过程质量没有显著改善效果。电子临床决策支持系统的较长使用期和人员保留对系统效率至关重要，并且可以减少投入资源。要实现该系统的收益，需要有效实施和有利的医疗系统。
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