Return on investment of a model of access combining triage with initial management: an economic analysis

Objectives Timely access to outpatient services is a major issue for public health systems. To address this issue, we aimed to establish the return on investment to the health system of the implementation of an alternative model for access and triage (Specific Timely Appointments for Triage: STAT) c...

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Main Authors: Nicholas F Taylor, Jennifer J Watts, Bridie Kent, Katherine E Harding, David A Snowdon, Sandra G Leggat, Annie K Lewis
Format: Article
Language:English
Published: BMJ Publishing Group 2021-07-01
Series:BMJ Open
Online Access:https://bmjopen.bmj.com/content/11/7/e045096.full
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spelling doaj-fb1e4d49f3b74104a3ad95426f0832062021-08-07T16:33:13ZengBMJ Publishing GroupBMJ Open2044-60552021-07-0111710.1136/bmjopen-2020-045096Return on investment of a model of access combining triage with initial management: an economic analysisNicholas F Taylor0Jennifer J Watts1Bridie Kent2Katherine E Harding3David A Snowdon4Sandra G Leggat5Annie K Lewis6Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, AustraliaSchool of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, AustraliaSchool of Nursing and Midwifery, Plymouth University, Plymouth, UKAllied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, AustraliaPeninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, AustraliaSchool of Psychology and Public Health, La Trobe University, Bundoora, Victoria, AustraliaAllied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, AustraliaObjectives Timely access to outpatient services is a major issue for public health systems. To address this issue, we aimed to establish the return on investment to the health system of the implementation of an alternative model for access and triage (Specific Timely Appointments for Triage: STAT) compared with a traditional waitlist model.Design Using a prospective pre–post design, an economic analysis was completed comparing the health system costs for participants who were referred for community outpatient services post-implementation of STAT with a traditional waitlist comparison group.Setting Eight community outpatient services of a health network in Melbourne, Australia.Participants Adults and children referred to community outpatient services.Interventions STAT combined targeted activities to reduce the existing waiting list and direct booking of patients into protected assessment appointments. STAT was compared with usual care, in which new patients were placed on a waiting list and offered appointments as space became available.Outcomes Health system costs included STAT implementation costs, outpatient health service use, emergency department presentations and hospital admissions 3 months before and after initial outpatient appointment. Waiting time was the primary outcome. Incremental cost-effectiveness ratios (ICERs) were estimated from the health system perspective.Results Data from 557 participants showed a 16.9 days or 29% (p<0.001) reduction in waiting time for first appointment with STAT compared with traditional waitlist. The ICER showed a cost of $A10 (95% CI −19 to 39) per day reduction in waiting time with STAT compared with traditional waitlist. Modelling showed the cost reduced to $A4 (95% CI −25 to 32) per day of reduction in waiting, if reduction in waiting times is sustained for 12 months.Conclusions There was a significant reduction in waiting time with the introduction of STAT at minimal cost to the health system.Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12615001016527).https://bmjopen.bmj.com/content/11/7/e045096.full
collection DOAJ
language English
format Article
sources DOAJ
author Nicholas F Taylor
Jennifer J Watts
Bridie Kent
Katherine E Harding
David A Snowdon
Sandra G Leggat
Annie K Lewis
spellingShingle Nicholas F Taylor
Jennifer J Watts
Bridie Kent
Katherine E Harding
David A Snowdon
Sandra G Leggat
Annie K Lewis
Return on investment of a model of access combining triage with initial management: an economic analysis
BMJ Open
author_facet Nicholas F Taylor
Jennifer J Watts
Bridie Kent
Katherine E Harding
David A Snowdon
Sandra G Leggat
Annie K Lewis
author_sort Nicholas F Taylor
title Return on investment of a model of access combining triage with initial management: an economic analysis
title_short Return on investment of a model of access combining triage with initial management: an economic analysis
title_full Return on investment of a model of access combining triage with initial management: an economic analysis
title_fullStr Return on investment of a model of access combining triage with initial management: an economic analysis
title_full_unstemmed Return on investment of a model of access combining triage with initial management: an economic analysis
title_sort return on investment of a model of access combining triage with initial management: an economic analysis
publisher BMJ Publishing Group
series BMJ Open
issn 2044-6055
publishDate 2021-07-01
description Objectives Timely access to outpatient services is a major issue for public health systems. To address this issue, we aimed to establish the return on investment to the health system of the implementation of an alternative model for access and triage (Specific Timely Appointments for Triage: STAT) compared with a traditional waitlist model.Design Using a prospective pre–post design, an economic analysis was completed comparing the health system costs for participants who were referred for community outpatient services post-implementation of STAT with a traditional waitlist comparison group.Setting Eight community outpatient services of a health network in Melbourne, Australia.Participants Adults and children referred to community outpatient services.Interventions STAT combined targeted activities to reduce the existing waiting list and direct booking of patients into protected assessment appointments. STAT was compared with usual care, in which new patients were placed on a waiting list and offered appointments as space became available.Outcomes Health system costs included STAT implementation costs, outpatient health service use, emergency department presentations and hospital admissions 3 months before and after initial outpatient appointment. Waiting time was the primary outcome. Incremental cost-effectiveness ratios (ICERs) were estimated from the health system perspective.Results Data from 557 participants showed a 16.9 days or 29% (p<0.001) reduction in waiting time for first appointment with STAT compared with traditional waitlist. The ICER showed a cost of $A10 (95% CI −19 to 39) per day reduction in waiting time with STAT compared with traditional waitlist. Modelling showed the cost reduced to $A4 (95% CI −25 to 32) per day of reduction in waiting, if reduction in waiting times is sustained for 12 months.Conclusions There was a significant reduction in waiting time with the introduction of STAT at minimal cost to the health system.Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12615001016527).
url https://bmjopen.bmj.com/content/11/7/e045096.full
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