Cargando…
Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital
OBJECTIVE: 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. DESIGN: Discrete event simulation was us...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5595193/ https://www.ncbi.nlm.nih.gov/pubmed/28882905 http://dx.doi.org/10.1136/bmjopen-2016-014509 |
_version_ | 1783263327609159680 |
---|---|
author | Anderson, Gillian H Jenkins, Paul J McDonald, David A Van Der Meer, Robert Morton, Alec Nugent, Margaret Rymaszewski, Lech A |
author_facet | Anderson, Gillian H Jenkins, Paul J McDonald, David A Van Der Meer, Robert Morton, Alec Nugent, Margaret Rymaszewski, Lech A |
author_sort | Anderson, Gillian H |
collection | PubMed |
description | OBJECTIVE: 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. DESIGN: 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). SETTING: The orthopaedic unit VFC pathway pioneered at Glasgow Royal Infirmary has attracted significant attention and interest and is the focus of this cost study. OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSIONS: 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. |
format | Online Article Text |
id | pubmed-5595193 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-55951932017-10-10 Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital Anderson, Gillian H Jenkins, Paul J McDonald, David A Van Der Meer, Robert Morton, Alec Nugent, Margaret Rymaszewski, Lech A BMJ Open Health Economics OBJECTIVE: 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. DESIGN: 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). SETTING: The orthopaedic unit VFC pathway pioneered at Glasgow Royal Infirmary has attracted significant attention and interest and is the focus of this cost study. OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSIONS: 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. BMJ Publishing Group 2017-09-07 /pmc/articles/PMC5595193/ /pubmed/28882905 http://dx.doi.org/10.1136/bmjopen-2016-014509 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Health Economics Anderson, Gillian H Jenkins, Paul J McDonald, David A Van Der Meer, Robert Morton, Alec Nugent, Margaret Rymaszewski, Lech A Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital |
title | Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital |
title_full | Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital |
title_fullStr | Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital |
title_full_unstemmed | Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital |
title_short | Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital |
title_sort | cost comparison of orthopaedic fracture pathways using discrete event simulation in a glasgow hospital |
topic | Health Economics |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5595193/ https://www.ncbi.nlm.nih.gov/pubmed/28882905 http://dx.doi.org/10.1136/bmjopen-2016-014509 |
work_keys_str_mv | AT andersongillianh costcomparisonoforthopaedicfracturepathwaysusingdiscreteeventsimulationinaglasgowhospital AT jenkinspaulj costcomparisonoforthopaedicfracturepathwaysusingdiscreteeventsimulationinaglasgowhospital AT mcdonalddavida costcomparisonoforthopaedicfracturepathwaysusingdiscreteeventsimulationinaglasgowhospital AT vandermeerrobert costcomparisonoforthopaedicfracturepathwaysusingdiscreteeventsimulationinaglasgowhospital AT mortonalec costcomparisonoforthopaedicfracturepathwaysusingdiscreteeventsimulationinaglasgowhospital AT nugentmargaret costcomparisonoforthopaedicfracturepathwaysusingdiscreteeventsimulationinaglasgowhospital AT rymaszewskilecha costcomparisonoforthopaedicfracturepathwaysusingdiscreteeventsimulationinaglasgowhospital |