Measuring the benefit of performance improvement and decision support

• HIT Description: Hypothetical decision support program More info...
  
• Purpose of Study: Describe a methodology for measuring the direct and indirect costs and qualitative and quantitative benefits of decision support activities.
  
• Years of study: Not Available
  
• Study Design: Illustrative return-on-investment (ROI) analysis
  
• Outcomes: Return-on-investment
  

• Settings: A large private teaching hospital.
• Intervention: Give hypothetical interventions in the system designed to prevent medication errors: 1) Provision of information at the prescribing stage; 2) Physician computer order entry; 3) Pharmacy system; 4) Automated medication dispensing systems; 5) Comprehensive medication delivery system assuming changes were made at all four stages of the processes.
• Evaluation Method: A dynamic computer simulation model was constructed to model hospital medication errors. Parameters of the model were estimated from a study of prescription errors on two hospital medical/surgical units and used in the baseline simulation. Five prevention strategies were simulated based on information obtained from the literature.
• HIT System: Hypothetical medication delivery systems in a hospital
• Clinical Outcomes: Baseline medication error is estimated to be 4.2%, of which 8% to 26% will result in ADEs. The five prevention strategies can reduce the medication errors by 5.2%, 12.7%, 7.5%, 5.6%, and 26.3% respectively. Assuming an ADE results in 2.2 additional days of hospitalization on the average. The baseline ADEs in a hospital could result in from 1,400 to 4,654 days of extra hospitalization. The model estimated that the implementation of a comprehensive medication delivery system (Intervention #5, the optimal scenario) could save from 340 to 1,226 days of hospitalization. The simulation results are sensitive to the distribution of errors in the hospital, costs of an ADE, and the proportion of medication errors resulting gin ADEs.
• Benefits: Assuming the cost of the additional days of hospitalization is $2,595 (not stated as to year, presumably 2000 or 2001 dollars), an integrated comprehensive medication delivery system can save up to $1.4 million in costs associated with ADEs annually in a large hospital (i.e., 26.3% savings). These savings reflect only direct hospital costs.