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)

Peter L. Elkin, Mark Liebow, Brent A. Bauer, Swarna Chaliki, Dietlind Wahner-Roedler, John Bundrick, Mark Lee, Steven H. Brown, David Froehling, Kent Bailey, Kathleen Famiglietti, Richard Kim, Ed Hoffer, Mitchell Feldman, G. Octo Barnett

Research output: Contribution to journalArticle

34 Scopus citations

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 languageEnglish (US)
Pages (from-to)772-777
Number of pages6
JournalInternational Journal of Medical Informatics
Volume79
Issue number11
DOIs
StatePublished - Nov 2010

Keywords

  • Clinical decision support
  • Expert systems
  • Medical economics
  • Medical education

ASJC Scopus subject areas

  • Health Informatics

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