Transaction cost analysis of in-clinic versus telehealth consultations for chronic pain: preliminary evidence for rapid and affordable access to interdisciplinary collaborative consultation.
Transaction cost analysis of in-clinic versus telehealth consultations for chronic pain: preliminary evidence for rapid and affordable access to interdisciplinary collaborative consultation.
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DOI：
10.1111/pme.12688
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发表时间：
2015-06
期刊：
影响因子：
--
通讯作者：
Doorenbos AZ
中科院分区：
文献类型：
--
作者：
Theodore BR;Whittington J;Towle C;Tauben DJ;Endicott-Popovsky B;Cahana A;Doorenbos AZ
随着降低成本和提高疼痛管理质量的要求不断增加，医疗保健机构面临着采用创新技术和改变工作流程以提供基于价值的护理的挑战。交易成本经济分析可以对这些护理服务变化的后果进行比较评估。本研究的目的是使用交易成本分析建立概念验证，以检查诊所内和远程医疗的慢性疼痛管理。参与的医疗保健提供者被要求识别并描述慢性疼痛患者的两项可比较的已完成交易：一项是患者与诊所专家之间的咨询，另一项是初级保健提供者向疼痛医学专家团队远程医疗介绍患者的病例。每个提供商完成了两次现场访谈。重点是每笔交易的时间、时间价值和劳动力成本。确定了提供者和患者的步骤数、时间和成本。诊所内交易采取了 46 个离散步骤，远程医疗交易采取了 27 个步骤。尽管每个患者的成本相似（诊所内 332.89 美元，远程医疗 376.48 美元），但诊所内的成本和远程医疗 4 个工作日内的成本是累计的。从转诊到完成初次咨询之间的时间间隔为诊所 72 天，远程医疗为 4 天。美国医疗保健正在转向使用更多的技术和实践，疼痛管理护理服务的交易成本分析所提供的信息对于确定实际成本节省和效益非常重要。
With ever increasing mandates to reduce costs and increase the quality of pain management, health care institutions are faced with the challenge of adopting innovative technologies and shifting workflows to provide value-based care. Transaction cost economic analysis can provide comparative evaluation of the consequences of these changes in the delivery of care. The aim of this study was to establish proof-of-concept using transaction cost analysis to examine chronic pain management in-clinic and through telehealth. Participating health care providers were asked to identify and describe two comparable completed transactions for patients with chronic pain: one consultation between patient and specialist in-clinic and the other a telehealth presentation of a patient’s case by the primary care provider to a team of pain medicine specialists. Each provider completed two on-site interviews. Focus was on the time, value of time, and labor costs per transaction. Number of steps, time, and costs for providers and patients were identified. Forty-six discrete steps were taken for the in-clinic transaction, and 27 steps were taken for the telehealth transaction. Although similar in costs per patient ($332.89 in-clinic vs. $376.48 telehealth), the costs accrued over 153 business days in-clinic and 4 business days for telehealth. Time elapsed between referral and completion of initial consultation was 72 days in-clinic, 4 days for telehealth. U.S. health care is moving toward the use of more technologies and practices, and the information provided by transaction cost analyses of care delivery for pain management will be important to determine actual cost savings and benefits.
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DOI：
10.1016/j.tra.2004.11.001
发表时间：
2005-05-01
影响因子：
6.4
作者：
Brownstone, D;Small, KA
通讯作者：
Small, KA
影响因子：
4.9
作者：
Baldwin, Laura-Mae;Hollow, Walter B.;Grossman, David C.
通讯作者：
Grossman, David C.
影响因子：
4.9
作者：
Baldwin, LM;Patanian, MM;Hart, LG
通讯作者：
Hart, LG
影响因子：
3.1
作者：
Davies, Stephanie;Quintner, John;Schug, Stephan A.
通讯作者：
Schug, Stephan A.
影响因子：
3.1
作者：
Cahana, Alex;Dansie, Elizabeth J.;Turk, Dennis C.
通讯作者：
Turk, Dennis C.