Int J Med Inform - The introduction of a diagnostic decision support system (DXplain?) into the workflow of a teaching hospital service can decrease the cost of service for diagnostically challenging Diagnostic Related Groups (DRGs).

Tópicos

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Resumo

CKGROUND: In an era of short inpatient stays, residents may overlook relevant elements of the differential diagnosis as they try to evaluate and treat patients. However, if a resident's first principal diagnosis is wrong, the patient's appropriate evaluation and treatment may take longer, cost more, and lead to worse outcomes. A diagnostic decision support system may lead to the generation of a broader differential diagnosis that more often includes the correct diagnosis, permitting a shorter, more effective, and less costly hospital stay.METHODS: We provided residents on General Medicine services access to DXplain, an established computer-based diagnostic decision support system, for 6 months. We compared charges and cost of service for diagnostically challenging cases seen during the fourth through sixth month of access to DXplain (intervention period) to control cases seen in the 6 months before the system was made available.RESULTS: 564 cases were identified as diagnostically challenging by our criteria during the intervention period along with 1173 cases during the control period. Total charges were $1281 lower (p=.006), Medicare Part A charges $1032 lower (p=0.006) and cost of service $990 lower (p=0.001) per admission in the intervention cases than in control cases.CONCLUSIONS: Using DXplain on all diagnostically challenging cases might save our medical center over $2,000,000 a year on the General Medicine Services alone. Using clinical diagnostic decision support systems may improve quality and decrease cost substantially at teaching hospitals.

Resumo Limpo

ckground era short inpati stay resid may overlook relev element differenti diagnosi tri evalu treat patient howev resid first princip diagnosi wrong patient appropri evalu treatment may take longer cost lead wors outcom diagnost decis support system may lead generat broader differenti diagnosi often includ correct diagnosi permit shorter effect less cost hospit staymethod provid resid general medicin servic access dxplain establish computerbas diagnost decis support system month compar charg cost servic diagnost challeng case seen fourth sixth month access dxplain intervent period control case seen month system made availableresult case identifi diagnost challeng criteria intervent period along case control period total charg lower p medicar part charg lower p cost servic lower p per admiss intervent case control casesconclus use dxplain diagnost challeng case might save medic center year general medicin servic alon use clinic diagnost decis support system may improv qualiti decreas cost substanti teach hospit

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