Programmatic Costs of the Telehealth Ostomy Self-Management Training: An Application of Time-Driven Activity-Based Costing

ObjectivesProgrammatic cost assessment of novel clinical interventions can inform their widespread dissemination and implementation. This study aimed to determine the programmatic costs of a telehealth Ostomy Self-Management Training (OSMT) intervention for cancer survivors using Time-Driven Activity-Based Costing (TDABC) methodology.MethodsWe demonstrated a step-by-step application of TDABC based on a process map with core OSMT intervention activities and associated procedures and determined resource use and costs, per unit procedure. We also assessed per-patient costs from a payer perspective and provided estimates of total hours and costs by personnel, activity, and procedure.ResultsThe per-patient cost of the OSMT was $1758. Personnel time accounted for 91% of the total cost. Site supervisor and information technology technician time were the most expensive personnel resources. Telehealth technical and communication equipment accounted for 8% of the total cost. Intervention coordination and monitoring efforts represented most of the total time cost (62%), followed by the intervention delivery (35%). The procedures with the highest cost were communication via phone or virtual meetings (24%), email exchanges (18%), and telehealth session delivery (18%).ConclusionsFuture efforts to replicate, disseminate, and implement the OSMT intervention should anticipate funding for nonclinical components of the intervention, including coordination and monitoring, and consider how these activities can be performed most efficiently. For institutions without established telemedicine programs, selection of videoconferencing platforms and adequate staffing for participant technical support should be considered. Our step-by-step application of TDABC serves as a case study demonstrating how interventionists can gather data on resource use and costs of intervention activities concurrently with their collection of trial data.     

应用时间驱动作业成本法优化急诊医疗服务流程*

目的 通过建立测算模型,对急诊3种常见疾病进行成本核算,以提升急诊服务质量。方法 运用时间驱动作业成本法（TDABC）、专家访谈法、现场调研法进行相关研究。结果 急诊3种疾病患者成本由高到低依次为意识障碍患者（436.27元）、呼吸衰竭患者（287.60元）、胸痛患者（253.16元）。TDABC法考虑了急诊医务人员的人力资源成本和时间成本,测算结果更符合实际。结论 TDABC法较现行的成本核算系统更精确,并且可以帮助急诊科优化诊疗流程,进行成本管控,提高医疗效率,降低患者医疗成本,以不断提升急诊服务水平。     

基于时间驱动作业成本法的超声室医疗服务项目成本核算

目的:探索基于时间驱动作业成本法(TDABC)医疗服务项目成本核算方法,并与传统作业成本法的计算结果进行比较,为国内医院项目成本核算的方法选择提供参考依据。方法:采用TDABC对样本医院超声科9项医疗服务项目进行成本核算,采用Wilcoxon配对符号秩和检验对TDABC与传统作业成本法结果进行分析,比较不同方法核算出的医疗服务项目成本结果之间是否具有差异性。结果:TDABC方法可以通过时间动因将科室成本分摊至项目成本,其核算过程简便,符合医院的实际成本•与传统作业成本法相比核算结果无统计学差异。结论:TDABC方法是一种便捷准确的项目成本核算方法,依据其核算过程的特点,建立医院成本管理及核算制度方案,加强监督管理并合理分配各职能岗位,确保医疗项目成本核算的各个环节均有章可循。