TY - JOUR
T1 - Return on investment of a model of access combining triage with initial management
T2 - An economic analysis
AU - Snowdon, David A.
AU - Harding, Katherine E.
AU - Taylor, Nicholas F.
AU - Leggat, Sandra G.
AU - Kent, Bridie
AU - Lewis, Annie K.
AU - Watts, Jennifer J.
N1 - Funding Information:
Funding This work was supported by the National Health and Medical Research Council of Australia through a Partnerships for Better Health Grant (APP 1076777), with contributions from industry partners Eastern Health (in-kind) and the Victorian Department of Health and Human Services (direct and in-kind).
Publisher Copyright:
© Authors 2021
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/7
Y1 - 2021/7
N2 - Objectives Timely access to outpatient services is a major issue for public health systems. To address this issue, we aimed to establish the return on investment to the health system of the implementation of an alternative model for access and triage (Specific Timely Appointments for Triage: STAT) compared with a traditional waitlist model. Design Using a prospective pre-post design, an economic analysis was completed comparing the health system costs for participants who were referred for community outpatient services post-implementation of STAT with a traditional waitlist comparison group. Setting Eight community outpatient services of a health network in Melbourne, Australia. Participants Adults and children referred to community outpatient services. Interventions STAT combined targeted activities to reduce the existing waiting list and direct booking of patients into protected assessment appointments. STAT was compared with usual care, in which new patients were placed on a waiting list and offered appointments as space became available. Outcomes Health system costs included STAT implementation costs, outpatient health service use, emergency department presentations and hospital admissions 3 months before and after initial outpatient appointment. Waiting time was the primary outcome. Incremental cost-effectiveness ratios (ICERs) were estimated from the health system perspective. Results Data from 557 participants showed a 16.9 days or 29% (p<0.001) reduction in waiting time for first appointment with STAT compared with traditional waitlist. The ICER showed a cost of A10 (95% CI -19 to 39) per day reduction in waiting time with STAT compared with traditional waitlist. Modelling showed the cost reduced to A4 (95% CI -25 to 32) per day of reduction in waiting, if reduction in waiting times is sustained for 12 months. Conclusions There was a significant reduction in waiting time with the introduction of STAT at minimal cost to the health system. Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12615001016527).
AB - Objectives Timely access to outpatient services is a major issue for public health systems. To address this issue, we aimed to establish the return on investment to the health system of the implementation of an alternative model for access and triage (Specific Timely Appointments for Triage: STAT) compared with a traditional waitlist model. Design Using a prospective pre-post design, an economic analysis was completed comparing the health system costs for participants who were referred for community outpatient services post-implementation of STAT with a traditional waitlist comparison group. Setting Eight community outpatient services of a health network in Melbourne, Australia. Participants Adults and children referred to community outpatient services. Interventions STAT combined targeted activities to reduce the existing waiting list and direct booking of patients into protected assessment appointments. STAT was compared with usual care, in which new patients were placed on a waiting list and offered appointments as space became available. Outcomes Health system costs included STAT implementation costs, outpatient health service use, emergency department presentations and hospital admissions 3 months before and after initial outpatient appointment. Waiting time was the primary outcome. Incremental cost-effectiveness ratios (ICERs) were estimated from the health system perspective. Results Data from 557 participants showed a 16.9 days or 29% (p<0.001) reduction in waiting time for first appointment with STAT compared with traditional waitlist. The ICER showed a cost of A10 (95% CI -19 to 39) per day reduction in waiting time with STAT compared with traditional waitlist. Modelling showed the cost reduced to A4 (95% CI -25 to 32) per day of reduction in waiting, if reduction in waiting times is sustained for 12 months. Conclusions There was a significant reduction in waiting time with the introduction of STAT at minimal cost to the health system. Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12615001016527).
KW - health economics
KW - health services administration & management
KW - public health
UR - http://www.scopus.com/inward/record.url?scp=85111161410&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2020-045096
DO - 10.1136/bmjopen-2020-045096
M3 - Article
C2 - 34290062
AN - SCOPUS:85111161410
SN - 2044-6055
VL - 11
JO - BMJ Open
JF - BMJ Open
IS - 7
M1 - e045096
ER -
