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Protocol for evaluation of the cost-effectiveness of ePrescribing systems and candidate prototype for other related health information technologies
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Lilford, Richard, Girling, Alan J., Sheikh, Aziz, Coleman, Jamie J., Chilton, Peter J., Burn, Samantha L., Jenkinson, David J., Blake, Laurence and Hemming, Karla (2014) Protocol for evaluation of the cost-effectiveness of ePrescribing systems and candidate prototype for other related health information technologies. BMC Health Services Research, Volume 14 (Number 1). Article number 314. doi:10.1186/1472-6963-14-314
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Official URL: http://dx.doi.org/10.1186/1472-6963-14-314
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.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RA Public aspects of medicine | ||||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Information storage and retrieval systems -- Medical care, Medical informatics, Medical economics | ||||||||
| Journal or Publication Title: | BMC Health Services Research | ||||||||
| Publisher: | Biomed central | ||||||||
| ISSN: | 1472-6963 | ||||||||
| Official Date: | 19 July 2014 | ||||||||
| Dates: |
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| Date of first compliant deposit: | 28 December 2015 | ||||||||
| Volume: | Volume 14 | ||||||||
| Number: | Number 1 | ||||||||
| Number of Pages: | 12 | ||||||||
| Article Number: | Article number 314 | ||||||||
| DOI: | 10.1186/1472-6963-14-314 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access | ||||||||
| Funder: | National Institute for Health Research (Great Britain) (NIHR), Engineering and Physical Sciences Research Council (EPSRC), Medical Research Council (Great Britain) (MRC), Commonwealth Fund, National Institute for Health and Clinical Excellence (Great Britain) (NICE), Higher Education Funding Council for England (HEFCE) | ||||||||
| Grant number: | GR/S29874/01 (EPSRC), G0800808 (MRC), RP-PG-1209-10099 (NIHR), G0900909 (MRC), |
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