Abstract
Background: In an era of short inpatient stays, residents may overlook relevant elements of the differential diagnosis as they try to evaluate and treat patients. However, if a resident's first principal diagnosis is wrong, the patient's appropriate evaluation and treatment may take longer, cost more, and lead to worse outcomes. A diagnostic decision support system may lead to the generation of a broader differential diagnosis that more often includes the correct diagnosis, permitting a shorter, more effective, and less costly hospital stay. Methods: We provided residents on General Medicine services access to DXplain, an established computer-based diagnostic decision support system, for 6 months. We compared charges and cost of service for diagnostically challenging cases seen during the fourth through sixth month of access to DXplain (intervention period) to control cases seen in the 6 months before the system was made available. Results: 564 cases were identified as diagnostically challenging by our criteria during the intervention period along with 1173 cases during the control period. Total charges were $1281 lower (p=006), Medicare Part A charges $1032 lower (p=0.006) and cost of service $990 lower (p=0.001) per admission in the intervention cases than in control cases. Conclusions: Using DXplain on all diagnostically challenging cases might save our medical center over $2,000,000 a year on the General Medicine Services alone. Using clinical diagnostic decision support systems may improve quality and decrease cost substantially at teaching hospitals.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 772-777 |
| Number of pages | 6 |
| Journal | International Journal of Medical Informatics |
| Volume | 79 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 2010 |
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Keywords
- Clinical decision support
- Expert systems
- Medical economics
- Medical education
ASJC Scopus subject areas
- Health Informatics
Cite this
The introduction of a diagnostic decision support system (DXplain™) into the workflow of a teaching hospital service can decrease the cost of service for diagnostically challenging Diagnostic Related Groups (DRGs). / Elkin, Peter L.; Liebow, Mark; Bauer, Brent A; Chaliki, Swarna; Wahner-Roedler, Dietlind; Bundrick, John; Lee, Mark; Brown, Steven H.; Froehling, David; Bailey, Kent R; Famiglietti, Kathleen; Kim, Richard; Hoffer, Ed; Feldman, Mitchell; Barnett, G. Octo.
In: International Journal of Medical Informatics, Vol. 79, No. 11, 11.2010, p. 772-777.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The introduction of a diagnostic decision support system (DXplain™) into the workflow of a teaching hospital service can decrease the cost of service for diagnostically challenging Diagnostic Related Groups (DRGs)
AU - Elkin, Peter L.
AU - Liebow, Mark
AU - Bauer, Brent A
AU - Chaliki, Swarna
AU - Wahner-Roedler, Dietlind
AU - Bundrick, John
AU - Lee, Mark
AU - Brown, Steven H.
AU - Froehling, David
AU - Bailey, Kent R
AU - Famiglietti, Kathleen
AU - Kim, Richard
AU - Hoffer, Ed
AU - Feldman, Mitchell
AU - Barnett, G. Octo
PY - 2010/11
Y1 - 2010/11
N2 - Background: In an era of short inpatient stays, residents may overlook relevant elements of the differential diagnosis as they try to evaluate and treat patients. However, if a resident's first principal diagnosis is wrong, the patient's appropriate evaluation and treatment may take longer, cost more, and lead to worse outcomes. A diagnostic decision support system may lead to the generation of a broader differential diagnosis that more often includes the correct diagnosis, permitting a shorter, more effective, and less costly hospital stay. Methods: We provided residents on General Medicine services access to DXplain, an established computer-based diagnostic decision support system, for 6 months. We compared charges and cost of service for diagnostically challenging cases seen during the fourth through sixth month of access to DXplain (intervention period) to control cases seen in the 6 months before the system was made available. Results: 564 cases were identified as diagnostically challenging by our criteria during the intervention period along with 1173 cases during the control period. Total charges were $1281 lower (p=006), Medicare Part A charges $1032 lower (p=0.006) and cost of service $990 lower (p=0.001) per admission in the intervention cases than in control cases. Conclusions: Using DXplain on all diagnostically challenging cases might save our medical center over $2,000,000 a year on the General Medicine Services alone. Using clinical diagnostic decision support systems may improve quality and decrease cost substantially at teaching hospitals.
AB - Background: In an era of short inpatient stays, residents may overlook relevant elements of the differential diagnosis as they try to evaluate and treat patients. However, if a resident's first principal diagnosis is wrong, the patient's appropriate evaluation and treatment may take longer, cost more, and lead to worse outcomes. A diagnostic decision support system may lead to the generation of a broader differential diagnosis that more often includes the correct diagnosis, permitting a shorter, more effective, and less costly hospital stay. Methods: We provided residents on General Medicine services access to DXplain, an established computer-based diagnostic decision support system, for 6 months. We compared charges and cost of service for diagnostically challenging cases seen during the fourth through sixth month of access to DXplain (intervention period) to control cases seen in the 6 months before the system was made available. Results: 564 cases were identified as diagnostically challenging by our criteria during the intervention period along with 1173 cases during the control period. Total charges were $1281 lower (p=006), Medicare Part A charges $1032 lower (p=0.006) and cost of service $990 lower (p=0.001) per admission in the intervention cases than in control cases. Conclusions: Using DXplain on all diagnostically challenging cases might save our medical center over $2,000,000 a year on the General Medicine Services alone. Using clinical diagnostic decision support systems may improve quality and decrease cost substantially at teaching hospitals.
KW - Clinical decision support
KW - Expert systems
KW - Medical economics
KW - Medical education
UR - http://www.scopus.com/inward/record.url?scp=78049247075&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=78049247075&partnerID=8YFLogxK
U2 - 10.1016/j.ijmedinf.2010.09.004
DO - 10.1016/j.ijmedinf.2010.09.004
M3 - Article
C2 - 20951080
AN - SCOPUS:78049247075
VL - 79
SP - 772
EP - 777
JO - International Journal of Medical Informatics
JF - International Journal of Medical Informatics
SN - 1386-5056
IS - 11
ER -