Cost-effectiveness of a quality improvement project, including simulation-based training, on reducing door-to-needle times in stroke thrombolysis
| Autor: | Hege Langli Ersdal, Thomas Lindner, Mayank Goyal, S. Barry Issenberg, Martin W. Kurz, Soffien Chadli Ajmi, Corinna Vossius |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Quality management business.industry Cost effectiveness Cost-Benefit Analysis Health Policy medicine.medical_treatment Psychological intervention Thrombolysis Quality Improvement Brain Ischemia Stroke Emergency medicine Health care Humans Medicine Stroke thrombolysis Thrombolytic Therapy business Fixed cost Simulation based health care economics and organizations Retrospective Studies |
| Zdroj: | BMJ Quality & Safety. 31:569-578 |
| ISSN: | 2044-5423 2044-5415 |
| DOI: | 10.1136/bmjqs-2021-013398 |
| Popis: | BackgroundRapid revascularisation in acute ischaemic stroke is crucial to reduce its total burden including societal costs. A quality improvement (QI) project that included streamlining the stroke care pathway and simulation-based training was followed by a significant reduction in median door-to-needle time (27 to 13 min) and improved patient outcomes after stroke thrombolysis at our centre. Here, we present a retrospective cost-effectiveness analysis of the QI project.MethodsCosts for implementing and sustaining QI were assessed using recognised frameworks for economic evaluations. Effectiveness was calculated from previously published outcome measures. Cost-effectiveness was presented as incremental cost-effectiveness ratios including costs per minute door-to-needle time reduction per patient, and costs per averted death in the 13-month post-intervention period. We also estimated incremental cost-effectiveness ratios for a projected 5-year post-intervention period and for varying numbers of patients treated with thrombolysis. Furthermore, we performed a sensitivity analysis including and excluding costs of unpaid time.ResultsAll costs including fixed costs for implementing the QI project totalled US$44 802, while monthly costs were US$2141. We calculated a mean reduction in door-to-needle time of 13.1 min per patient and 6.36 annual averted deaths. Across different scenarios, the estimated costs per minute reduction in door-to-needle time per patient ranged from US$13 to US$29, and the estimated costs per averted death ranged from US$4679 to US$10 543.ConclusionsWe have shown that a QI project aiming to improve stroke thrombolysis treatment at our centre can be implemented and sustained at a relatively low cost with increasing cost-effectiveness over time. Our work builds on the emerging theory and practice for economic evaluations in QI projects and simulation-based training. The presented cost-effectiveness data might help guide healthcare leaders planning similar interventions. |
| Databáze: | OpenAIRE |
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