Limits...
Protocol for evaluation of the cost-effectiveness of ePrescribing systems and candidate prototype for other related health information technologies.

Lilford RJ, Girling AJ, Sheikh A, Coleman JJ, Chilton PJ, Burn SL, Jenkinson DJ, Blake L, Hemming K - BMC Health Serv Res (2014)

Bottom Line: The method we propose is use of Bayesian ideas as a philosophical guide.Assessment of cost-effectiveness requires a number of parameters in order to measure incremental cost utility or benefit - the effectiveness of the intervention in reducing frequency of preventable adverse events; utilities for these adverse events; costs of HIT systems; and cost consequences of adverse events averted.There is no single end-point that adequately and unproblematically captures the effectiveness of the intervention; we therefore plan to observe changes in error rates and adverse events in four error categories (death, permanent disability, moderate disability, minimal effect).However, the methodology we propose could be used whenever research cannot provide a direct and unbiased measure of comparative effectiveness.

View Article: PubMed Central - HTML - PubMed

Affiliation: Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK. r.j.lilford@warwick.ac.uk.

ABSTRACT

Background: This protocol concerns the assessment of cost-effectiveness of hospital health information technology (HIT) in four hospitals. Two of these hospitals are acquiring ePrescribing systems incorporating extensive decision support, while the other two will implement systems incorporating more basic clinical algorithms. Implementation of an ePrescribing system will have diffuse effects over myriad clinical processes, so the protocol has to deal with a large amount of information collected at various 'levels' across the system.

Methods/design: The method we propose is use of Bayesian ideas as a philosophical guide.Assessment of cost-effectiveness requires a number of parameters in order to measure incremental cost utility or benefit - the effectiveness of the intervention in reducing frequency of preventable adverse events; utilities for these adverse events; costs of HIT systems; and cost consequences of adverse events averted. There is no single end-point that adequately and unproblematically captures the effectiveness of the intervention; we therefore plan to observe changes in error rates and adverse events in four error categories (death, permanent disability, moderate disability, minimal effect). For each category we will elicit and pool subjective probability densities from experts for reductions in adverse events, resulting from deployment of the intervention in a hospital with extensive decision support. The experts will have been briefed with quantitative and qualitative data from the study and external data sources prior to elicitation. Following this, there will be a process of deliberative dialogues so that experts can "re-calibrate" their subjective probability estimates. The consolidated densities assembled from the repeat elicitation exercise will then be used to populate a health economic model, along with salient utilities. The credible limits from these densities can define thresholds for sensitivity analyses.

Discussion: The protocol we present here was designed for evaluation of ePrescribing systems. However, the methodology we propose could be used whenever research cannot provide a direct and unbiased measure of comparative effectiveness.

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Related in: MedlinePlus

Framework for the evaluation.
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Related In: Results  -  Collection

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Figure 2: Framework for the evaluation.

Mentions: The first two quantities (effectiveness in reducing adverse events, and utilities) are used to calculate health benefit (assuming that this cannot be captured directly through a quality of life measurement – see below). Component 4 allows net costs to be estimated. Costs and benefits can then be consolidated in a measure of incremental cost utility or cost benefit. An overall framework for our proposed evaluation is given in Figure 2. The perspective of the evaluation is that of the health services, at least in the first instance – a point to which we return.


Protocol for evaluation of the cost-effectiveness of ePrescribing systems and candidate prototype for other related health information technologies.

Lilford RJ, Girling AJ, Sheikh A, Coleman JJ, Chilton PJ, Burn SL, Jenkinson DJ, Blake L, Hemming K - BMC Health Serv Res (2014)

Framework for the evaluation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4118257&req=5

Figure 2: Framework for the evaluation.
Mentions: The first two quantities (effectiveness in reducing adverse events, and utilities) are used to calculate health benefit (assuming that this cannot be captured directly through a quality of life measurement – see below). Component 4 allows net costs to be estimated. Costs and benefits can then be consolidated in a measure of incremental cost utility or cost benefit. An overall framework for our proposed evaluation is given in Figure 2. The perspective of the evaluation is that of the health services, at least in the first instance – a point to which we return.

Bottom Line: The method we propose is use of Bayesian ideas as a philosophical guide.Assessment of cost-effectiveness requires a number of parameters in order to measure incremental cost utility or benefit - the effectiveness of the intervention in reducing frequency of preventable adverse events; utilities for these adverse events; costs of HIT systems; and cost consequences of adverse events averted.There is no single end-point that adequately and unproblematically captures the effectiveness of the intervention; we therefore plan to observe changes in error rates and adverse events in four error categories (death, permanent disability, moderate disability, minimal effect).However, the methodology we propose could be used whenever research cannot provide a direct and unbiased measure of comparative effectiveness.

View Article: PubMed Central - HTML - PubMed

Affiliation: Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK. r.j.lilford@warwick.ac.uk.

ABSTRACT

Background: This protocol concerns the assessment of cost-effectiveness of hospital health information technology (HIT) in four hospitals. Two of these hospitals are acquiring ePrescribing systems incorporating extensive decision support, while the other two will implement systems incorporating more basic clinical algorithms. Implementation of an ePrescribing system will have diffuse effects over myriad clinical processes, so the protocol has to deal with a large amount of information collected at various 'levels' across the system.

Methods/design: The method we propose is use of Bayesian ideas as a philosophical guide.Assessment of cost-effectiveness requires a number of parameters in order to measure incremental cost utility or benefit - the effectiveness of the intervention in reducing frequency of preventable adverse events; utilities for these adverse events; costs of HIT systems; and cost consequences of adverse events averted. There is no single end-point that adequately and unproblematically captures the effectiveness of the intervention; we therefore plan to observe changes in error rates and adverse events in four error categories (death, permanent disability, moderate disability, minimal effect). For each category we will elicit and pool subjective probability densities from experts for reductions in adverse events, resulting from deployment of the intervention in a hospital with extensive decision support. The experts will have been briefed with quantitative and qualitative data from the study and external data sources prior to elicitation. Following this, there will be a process of deliberative dialogues so that experts can "re-calibrate" their subjective probability estimates. The consolidated densities assembled from the repeat elicitation exercise will then be used to populate a health economic model, along with salient utilities. The credible limits from these densities can define thresholds for sensitivity analyses.

Discussion: The protocol we present here was designed for evaluation of ePrescribing systems. However, the methodology we propose could be used whenever research cannot provide a direct and unbiased measure of comparative effectiveness.

Show MeSH
Related in: MedlinePlus