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
AU - Famiglietti, Kathleen
AU - Kim, Richard
AU - Hoffer, Ed
AU - Feldman, Mitchell
AU - Barnett, G. Octo
N1 - Funding Information:
This work has been supported in part by a grant from the National Library of Medicine LM06918 , and grants from the Centers for Disease Control and Prevention PH000022 and HK00014 and in part by no-cost access to DXplain from the L aboratory of Computer Science, Massachusetts General Hospital .
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
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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 -