A patient-centered digital cost simulator based on Time-Driven Based-Activity Costing: a proof-of-concept study of knee replacement in two private Portuguese hospitals (Preprint)
Authors: Azevedo Salomé , von Hafe Francisco , Ramos Carolina , Leal João , Londral Ana Rita 
Published: April 2021

BACKGROUND

The number of knee replacement surgeries in OECD countries will continue rising due to the prevalence of osteoarthritis caused by aging and obesity. It is a cost-effective but expensive procedure. Consequently, decision-makers need accurate information on intervention outcomes and costs to manage the healthcare system efficiently. Literature proposed Time-Driven Based-Activity Costing (TDABC) as a cost measurement model that accounts for care cycle complexity, such as patient diversity and treatment variation. However, few studies show how to apply the TDABC model in a real context, considering the existing hospitals' information systems (IS).

OBJECTIVE

Our primary goal was to design a patient-centered digital cost simulator for assessing the provider's cost of care delivery that complemented the outcomes analysis in Knee Surgery. The secondary goal was to synthesize the learning experience of implementing the method in two Portuguese private hospitals of the same provider.

METHODS

The proof-of-concept study was designed based on the TDABC model. As the two hospitals had different care delivery chains for the same procedure, each hospital's study was independent. The unit cost of supplying capacity was calculated using data collected from interviews, literature reviews, and general ledger accounts. Both care delivery chains were defined using information from interviews with hospital staff and mapped using Visual Paradigm©. Time estimations were based on direct observation and data exported from hospitals' IS. The patient-centered digital cost simulator was created using Google Sheets. Through a focus group, the multidisciplinary team evaluated the model feasibility and generalisability.

RESULTS

A patient-centered digital cost simulator and the data structure that allows collecting the most relevant cost analysis data are presented. The main lessons learned are described through this paper and are based on practical application: (1) the patient journey must drive data collection, organization, and analysis for the TDABC implementation; (2) the implementation of TDABC in healthcare involves the commitment and dedication of the healthcare provider's teams; (3) breaking the activities into operations helps to obtain time estimations and allocate resources in the patient care pathway; (4) the listing of the used resources should follow the financial IS classification.

CONCLUSIONS

The simulator that was developed is still a proof-of-concept, but it enlightened the healthcare provider of future improvements in the existing IS infrastructure. The TDABC implementation requires that the hospitals' IS collect and interoperate different data sources (clinical, financial, and logistics) along the patient pathway. Therefore, future research should focus on developing effective and efficient interfaces to allow importing process, activity, resources, and time information from the existing IS and calculate the total costs of care per patient. Such data needs to be integrated with health outcomes measures in order to monitor healthcare interventions' value.