Anderson Gillian H, Jenkins Paul J, McDonald David A, Van Der Meer Robert, Morton Alec, Nugent Margaret, Rymaszewski Lech A
Department of Management Science, University of Strathclyde Business School, Glasgow, UK.
Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, UK.
BMJ Open. 2017 Sep 7;7(9):e014509. doi: 10.1136/bmjopen-2016-014509.
Healthcare faces the continual challenge of improving outcome while aiming to reduce cost. The aim of this study was to determine the micro cost differences of the Glasgow non-operative trauma virtual pathway in comparison to a traditional pathway.
Discrete event simulation was used to model and analyse cost and resource utilisation with an activity-based costing approach. Data for a full comparison before the process change was unavailable so we used a modelling approach, comparing a virtual fracture clinic (VFC) with a simulated traditional fracture clinic (TFC).
The orthopaedic unit VFC pathway pioneered at Glasgow Royal Infirmary has attracted significant attention and interest and is the focus of this cost study.
Our study focused exclusively on patients with non-operative trauma attending emergency department or the minor injuries unit and the subsequent step in the patient pathway. Retrospective studies of patient outcomes as a result of the protocol introductions for specific injuries are presented in association with activity costs from the models.
Patients are satisfied with the new pathway, the information provided and the outcome of their injuries (Evidence Level IV). There was a 65% reduction in the number of first outpatient face-to-face (f2f) attendances in orthopaedics. In the VFC pathway, the resources required per day were significantly lower for all staff groups (p≤0.001). The overall cost per patient of the VFC pathway was £22.84 (95% CI 21.74 to 23.92) per patient compared with £36.81 (95% CI 35.65 to 37.97) for the TFC pathway.
Our results give a clearer picture of the cost comparison of the virtual pathway over a wholly traditional f2f clinic system. The use of simulation-based stochastic costings in healthcare economic analysis has been limited to date, but this study provides evidence for adoption of this method as a basis for its application in other healthcare settings.
医疗保健领域面临着在努力降低成本的同时改善治疗效果的持续挑战。本研究的目的是确定格拉斯哥非手术创伤虚拟路径与传统路径相比的微观成本差异。
采用离散事件模拟，通过作业成本法对成本和资源利用进行建模和分析。由于在流程变更前无法获得完整比较的数据，因此我们采用建模方法，将虚拟骨折诊所（VFC）与模拟的传统骨折诊所（TFC）进行比较。
格拉斯哥皇家医院率先采用的骨科单元VFC路径引起了广泛关注，是本成本研究的重点。
我们的研究仅关注到急诊科或轻伤科室就诊的非手术创伤患者以及患者路径中的后续步骤。结合模型中的活动成本，呈现了因针对特定损伤引入方案而对患者治疗结果进行的回顾性研究。
患者对新路径、提供的信息以及损伤治疗结果感到满意（证据等级IV）。骨科首次门诊面对面就诊次数减少了65%。在VFC路径中，所有工作人员组每天所需的资源显著更低（p≤0.001）。VFC路径每位患者的总成本为22.84英镑（95%置信区间21.74至23.92），而TFC路径为36.81英镑（95%置信区间35.65至37.97）。
我们的结果更清晰地呈现了虚拟路径与完全传统的面对面诊所系统的成本比较情况。基于模拟的随机成本核算在医疗保健经济分析中的应用迄今有限，但本研究为采用该方法作为其在其他医疗保健环境中应用的基础提供了证据。
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