Comparative cost-benefit analysis of tele-homecare for community-dwelling elderly in Japan: Non-Government versus Government Supported Funding Models.

Abstract:

OBJECTIVE:Tele-homecare is gaining prominence as a viable care alternative, as evidenced by the increase in financial support from international governments to fund initiatives in their respective countries. The primary reason for the funding is to support efforts to reduce lags and increase capacity in access to care as well as to promote preventive measures that can avert costly emergent issues from arising. These efforts are especially important to super-aged and aging societies such as in Japan, many European countries, and the United States (US). However, to date and to our knowledge, a direct comparison of non-government vs. government-supported funding models for tele-homecare is particularly lacking in Japan. The aim of this study is to compare these operational models (i.e., non-government vs. government-supported funding) from a cost-benefit perspective. This simulation study applies to a Japanese hypothetical cohort with implications for other super-aged and aging societies abroad. METHODS:We performed a cost-benefit analysis (CBA) on two operational models for enabling tele-homecare for elderly community-dwelling cohorts based on a decision tree model, which we created with parameters from published literature. The two models examined are (a) Model 1-non-government-supported funding that includes monthly fixed charges paid by users for a portion of the operating costs, and (b) Model 2-government-supported funding that includes startup and installation costs only (i.e., no operating costs) and no monthly user charges. We performed base case cost-benefit analysis and probabilistic cost-benefit analysis with a Monte Carlo simulation. We calculated net benefit and benefit-to-cost ratios (BCRs) from the societal perspective with a five-year time horizon applying a 3% discount rate for both cost and benefit values. The cost of tele-homecare included (a) the startup system expense, averaged over a five-year depreciation period, and (b) operation expenses (i.e., labor and non-labor) per user per year. The benefit of tele-homecare was measured by annual willingness to pay (WTP) for tele-homecare by a user and medical expenditures avoided. Both costs and benefits were inflated using the relevant Japanese consumer price index (CPI) and converted into 2015 US dollars with purchasing power parity (PPP) adjusted. RESULTS:Base case net benefits of Model 1 and Model 2 were $417.00 and $97.30, respectively. Base case BCR of Model 1 tele-homecare was 1.63, while Model 2 was 1.03. The probabilistic analysis estimated mean (95%CI) for BCRs of Model 1 and Model 2 was 1.84 (1.89, 1.88) and 1.46 (1.43, 1.49), respectively. Sensitivity analysis showed robustness of Model 1 in 7 parameters but Model 2 was sensitive in all key parameters such as initial system cost, device cost, number of users, and medical expenditure saved. Break-even analysis showed that the system cost of Model 2 had to be under $187,500. CONCLUSIONS:Our results for each model collectively showed that tele-homecare in Japan is cost-saving to some extent. However, the government-funded model (i.e., Model 2), which typically requires use of all startup funding to be spent within the first year on system costs, was inferior to the monthly fee model (i.e., Model 1) that did not use the government funding for installation or continued operations, but rather incorporated a monthly fee from users to support the receipt of services via tele-homecare. While the benefits of Model 1 outweighed the benefits of Model 2, the government-subsidized method employed in Model 2 could be more beneficial in general if some explicit prequalifying estimated metrics are instituted prior to funding. Thus, governments need to require applicants requesting funding to note, at a minimum, (a) estimated costs, (b) the expected number of tele-homecare users, and expected benefits such as (c) WTP by the user, or (d) medical expenditure saved by tele-homecare as a means of financing some of the operational costs.

journal_name

Int J Med Inform

authors

Akiyama M,Abraham C

doi

10.1016/j.ijmedinf.2017.04.017

subject

Has Abstract

pub_date

2017-08-01 00:00:00

pages

1-9

eissn

1386-5056

issn

1872-8243

pii

S1386-5056(17)30105-3

journal_volume

104

pub_type

杂志文章
  • Ontology driven health information systems architectures enable pHealth for empowered patients.

    abstract::The paradigm shift from organization-centered to managed care and on to personal health settings increases specialization and distribution of actors and services related to the health of patients or even citizens before becoming patients. As a consequence, extended communication and cooperation is required between all...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2010.10.004

    authors: Blobel B

    更新日期:2011-02-01 00:00:00

  • Towards reinforcing telemedicine adoption amongst clinicians in Nigeria.

    abstract::Telemedicine systems have been considered as a necessary measure to alleviate the shortfall in skilled medical specialists in developing countries. However, the obvious challenge is whether clinicians are willing to use this technological innovation, which has aided medical practice globally. One factor which has rece...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2017.05.008

    authors: Adenuga KI,Iahad NA,Miskon S

    更新日期:2017-08-01 00:00:00

  • Socio-demographic differences in risk information seeking sources for non-steroidal anti-inflammatory drugs (NSAIDS).

    abstract:OBJECTIVES:Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed for musculoskeletal pain and inflammatory conditions. A better understanding of patient information seeking behavior can help bridge the gap between patient knowledge and health care resources. This study examines the primary sources of...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2016.07.017

    authors: Houser SH,Au DW,Miller MJ,Chen L,Outman RC,Ray MN,Saag KG,Weech-Maldonado R

    更新日期:2016-10-01 00:00:00

  • Perspectives and expectations for telemedicine opportunities from families of nursing home residents and caregivers in nursing homes.

    abstract:BACKGROUND:This study assessed current perspectives and expectations for telemedicine by nursing home caregivers and families of nursing home patients in Taipei, Taiwan. METHODS:A total of 116 interviews were conducted with family members (n=37) and caregivers (n=79) using an original, four-part questionnaire devised ...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2009.02.009

    authors: Chang JY,Chen LK,Chang CC

    更新日期:2009-07-01 00:00:00

  • Usability of quality measures for online health information: Can commonly used technical quality criteria be reliably assessed?

    abstract:PURPOSE:Many criteria have been developed to rate the quality of online health information. To effectively evaluate quality, consumers must use quality criteria that can be reliably assessed. However, few instruments have been validated for inter-rater agreement. Therefore, we assessed the degree to which two raters co...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2005.02.002

    authors: Bernstam EV,Sagaram S,Walji M,Johnson CW,Meric-Bernstam F

    更新日期:2005-08-01 00:00:00

  • Factors determining the adherence to antimicrobial guidelines and the adoption of computerised decision support systems by physicians: A qualitative study in three European hospitals.

    abstract:BACKGROUND AND OBJECTIVES:Antimicrobial stewardship (AMS) programs aim to optimize antibiotic use and reduce inappropriate prescriptions through a panel of interventions. The implementation of clinical guidelines is a core strategy of AMS programs. Nevertheless, their dissemination and application remain low. Computeri...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2020.104233

    authors: Catho G,Centemero NS,Catho H,Ranzani A,Balmelli C,Landelle C,Zanichelli V,Huttner BD,on the behalf of the Q-COMPASS study group.

    更新日期:2020-09-01 00:00:00

  • Introducing electronic messaging in Norwegian healthcare: unintended consequences for interprofessional collaboration.

    abstract:OBJECTIVE:The introduction of health information technologies (HIT) can lead to unintended consequences. We studied a newly introduced electronic messaging (e-messaging) system for communication between homecare providers and general practitioners (GPs) in Norway. The objective of this paper is to identify and discuss ...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2014.02.001

    authors: Melby L,Hellesø R

    更新日期:2014-05-01 00:00:00

  • Effectiveness of a clinical knowledge support system for reducing diagnostic errors in outpatient care in Japan: A retrospective study.

    abstract::Clinical evidence has indicated the effectiveness of computer-based systems for preventing and reducing diagnostic errors. Our study aimed to evaluate the effectiveness of UpToDate, a computer-based clinical knowledge management system, for reducing diagnostic errors. We retrospectively identified 100 patients who vis...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2017.09.010

    authors: Shimizu T,Nemoto T,Tokuda Y

    更新日期:2018-01-01 00:00:00

  • The usability axiom of medical information systems.

    abstract:INTRODUCTION:In this article we begin by connecting the concept of simplicity of user interfaces of information systems with that of usability, and the concept of complexity of the problem-solving in information systems with the concept of usefulness. We continue by stating "the usability axiom" of medical information ...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2006.05.039

    authors: Pantazi SV,Kushniruk A,Moehr JR

    更新日期:2006-12-01 00:00:00

  • GEMS: a system for automated cancer diagnosis and biomarker discovery from microarray gene expression data.

    abstract::The success of treatment of patients with cancer depends on establishing an accurate diagnosis. To this end, we have built a system called GEMS (gene expression model selector) for the automated development and evaluation of high-quality cancer diagnostic models and biomarker discovery from microarray gene expression ...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2005.05.002

    authors: Statnikov A,Tsamardinos I,Dosbayev Y,Aliferis CF

    更新日期:2005-08-01 00:00:00

  • An investigation of the efficacy of electronic consenting interfaces of research permissions management system in a hospital setting.

    abstract:PURPOSE:Ethical and legal requirements for healthcare providers in the United States, stipulate that patients sign a consent form prior to undergoing medical treatment or participating in a research study. Currently, the majority of the hospitals obtain these consents using paper-based forms, which makes patient prefer...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2013.04.008

    authors: Chalil Madathil K,Koikkara R,Obeid J,Greenstein JS,Sanderson IC,Fryar K,Moskowitz J,Gramopadhye AK

    更新日期:2013-09-01 00:00:00

  • Discharge and referral data exchange using global standards--the SCIPHOX project in Germany.

    abstract::The goal of the German project "Standardization of Communication between Information Systems in Physician Offices and Hospitals using XML" (aka SCIPHOX) in its first phase is to provide information exchange based on the Extended Markup Language XML between Hospital Information Systems (HIS) and Physician Office System...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/s1386-5056(03)00036-4

    authors: Heitmann KU,Schweiger R,Dudeck J

    更新日期:2003-07-01 00:00:00

  • Exploiting the terminological approach from CEN/TC251 and GALEN to support semantic interoperability of healthcare record systems.

    abstract::We apply the principles included in two CEN standards (ENV 12265, ENV 12264) to the analysis of the semantic structure of health record systems, to support their semantic interoperability. This result was made possible by dramatic methodological progress in the field of terminological systems--due to a worldwide evolu...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/s1386-5056(97)00116-0

    authors: Rossi Mori A,Consorti F

    更新日期:1998-02-01 00:00:00

  • Automation bias: empirical results assessing influencing factors.

    abstract:OBJECTIVE:To investigate the rate of automation bias - the propensity of people to over rely on automated advice and the factors associated with it. Tested factors were attitudinal - trust and confidence, non-attitudinal - decision support experience and clinical experience, and environmental - task difficulty. The par...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2014.01.001

    authors: Goddard K,Roudsari A,Wyatt JC

    更新日期:2014-05-01 00:00:00

  • Impact of simulation training on self-efficacy of outpatient health care providers to use electronic health records.

    abstract:OBJECTIVES:To examine whether simulation training enhanced self-efficacy of physicians and nurses who work in the outpatient setting to use electronic medical records, and whether the training changed their perceptions about the importance of electronic medical records (EMRs) in helping patients and improving patients'...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2015.02.003

    authors: Vuk J,Anders ME,Mercado CC,Kennedy RL,Casella J,Steelman SC

    更新日期:2015-06-01 00:00:00

  • A wearable approach for intraoperative physiological stress monitoring of multiple cooperative surgeons.

    abstract::It is known that excessive levels of occupational stress affect professionals' technical and non-technical skills and surgeons are no exception. However, very few studies address this problem in neurosurgeons. A system for monitoring cardiovascular strain and autonomic imbalance during intracranial aneurysm procedures...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2019.05.028

    authors: Pimentel G,Rodrigues S,Silva PA,Vilarinho A,Vaz R,Silva Cunha JP

    更新日期:2019-09-01 00:00:00

  • Motivating and assisting physical exercise in independently living older adults: a pilot study.

    abstract:BACKGROUND:With age reaction time, coordination and cognition tend to deteriorate, which may lead to gait impairments, falls and injuries. To reduce this problem in elderly and to improve health, well-being and independence, regular balance and strength exercises are recommended. However, elderly face strong barriers t...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2012.11.015

    authors: Silveira P,van het Reve E,Daniel F,Casati F,de Bruin ED

    更新日期:2013-05-01 00:00:00

  • A dynamic model for predicting graft function in kidney recipients' upcoming follow up visits: A clinical application of artificial neural network.

    abstract:BACKGROUND:Predicting the function of transplanted kidneys would help clinicians in individualized medical interventions. We aimed to develop and validate a predictive tool for a future value of estimated glomerular filtration rate (eGFR) at upcoming visits. METHODS:We used static and time-dependent covariates as inpu...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2018.09.012

    authors: Rashidi Khazaee P,Bagherzadeh J,Niazkhani Z,Pirnejad H

    更新日期:2018-11-01 00:00:00

  • EmerLoc: location-based services for emergency medical incidents.

    abstract:BACKGROUND:Recent developments in positioning systems and telecommunications have provided the technology needed for the development of location aware medical applications. We developed a system, named EmerLoc, which is based upon this technology and uses a set of sensors that are attached to the patient's body, a micr...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2006.07.010

    authors: Maglogiannis I,Hadjiefthymiades S

    更新日期:2007-10-01 00:00:00

  • A computer-based outpatient clinical referral system.

    abstract::The process of generating a clinical referral for a patient, and the resulting transfer of information from the primary care physician to the specialist and back again, are key components in the struggle to deliver less costly and more effective clinical care. We have created a computer-based, outpatient clinical refe...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/s1386-5056(99)00027-1

    authors: Sittig DF,Gandhi TK,Franklin M,Turetsky M,Sussman AJ,Fairchild DG,Bates DW,Komaroff AL,Teich JM

    更新日期:1999-08-01 00:00:00

  • Decaying relevance of clinical data towards future decisions in data-driven inpatient clinical order sets.

    abstract:OBJECTIVE:Determine how varying longitudinal historical training data can impact prediction of future clinical decisions. Estimate the "decay rate" of clinical data source relevance. MATERIALS AND METHODS:We trained a clinical order recommender system, analogous to Netflix or Amazon's "Customers who bought A also boug...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2017.03.006

    authors: Chen JH,Alagappan M,Goldstein MK,Asch SM,Altman RB

    更新日期:2017-06-01 00:00:00

  • Problem list completeness in electronic health records: A multi-site study and assessment of success factors.

    abstract:OBJECTIVE:To assess problem list completeness using an objective measure across a range of sites, and to identify success factors for problem list completeness. METHODS:We conducted a retrospective analysis of electronic health record data and interviews at ten healthcare organizations within the United States, United...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章,多中心研究

    doi:10.1016/j.ijmedinf.2015.06.011

    authors: Wright A,McCoy AB,Hickman TT,Hilaire DS,Borbolla D,Bowes WA 3rd,Dixon WG,Dorr DA,Krall M,Malholtra S,Bates DW,Sittig DF

    更新日期:2015-10-01 00:00:00

  • Design and implementation considerations for a personalized patient education system in burn care.

    abstract::Patient education is a significant factor in the provision of health care services, contributing to improved disease management and health care outcomes. Personalization has been suggested as a means for increasing patient education effectiveness and computer-based approaches have been explored as a possible means of ...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2004.04.021

    authors: Doupi P,van der Lei J

    更新日期:2005-03-01 00:00:00

  • An ontology-driven framework to support the dynamic formation of an interdisciplinary healthcare team.

    abstract:BACKGROUND AND PURPOSE:Teamwork has become a modus operandi in healthcare and delivery of patient care by an interdisciplinary healthcare team (IHT) is now a prevailing modality of care. We argue that a formal and automated support framework is needed for an IHT to properly leverage information technology resources. Su...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2020.104075

    authors: Wilk S,Kezadri-Hamiaz M,Amyot D,Michalowski W,Kuziemsky C,Catal N,Rosu D,Carrier M,Giffen R

    更新日期:2020-04-01 00:00:00

  • A unified representation of findings in clinical radiology using the UMLS and DICOM.

    abstract:PURPOSE:Collecting and analyzing findings constitute the basis of medical activity. Computer assisted medical activity raises the problem of modelling findings. We propose a unified representation of findings integrating the representations of findings in the GAMUTS in Radiology [M.M. Reeder, B. Felson, GAMUTS in radio...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2007.11.003

    authors: Bertaud V,Lasbleiz J,Mougin F,Burgun A,Duvauferrier R

    更新日期:2008-09-01 00:00:00

  • Twenty five years of medical informatics education at Heidelberg/Heilbronn: discussion of a specialized curriculum for medical informatics.

    abstract::The specialized university curriculum for medical informatics (MI) at the University of Heidelberg/School of Technology Heilbronn is one of the oldest educational approaches in the field of MI and has been successful now for 25 years with about 1000 graduates (Diplom-Informatikerin der Medizin or Diplom-Informatiker d...

    journal_title:International journal of medical informatics

    pub_type: 历史文章,杂志文章

    doi:10.1016/s1386-5056(98)00048-3

    authors: Leven FJ,Haux R

    更新日期:1998-06-01 00:00:00

  • Same system, different outcomes: comparing the transitions from two paper-based systems to the same computerized physician order entry system.

    abstract:OBJECTIVE:To compare how nurses in two different paper-based systems perceive the impact of a computerized physician order entry (CPOE) system on their medication-related activities. SETTING:13 non-surgical, adult inpatient wards in a Dutch academic hospital. METHODS:Questionnaire survey of 295 nurses before and 304 ...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2008.06.012

    authors: Niazkhani Z,van der Sijs H,Pirnejad H,Redekop WK,Aarts J

    更新日期:2009-03-01 00:00:00

  • Medical support system for continuation of care based on XML web technology.

    abstract::In this paper, the implementation of an Internet-based telematic service for medical support is presented, which was developed and operated in pilot form within the INTRANET HEALTH CLINIC project--a 2-year project supported by the European Commission under the Health Telematics Programme. The aim of the application is...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/s1386-5056(01)00195-2

    authors: Stalidis G,Prentza A,Vlachos IN,Maglavera S,Koutsouris D

    更新日期:2001-12-01 00:00:00

  • Global healthcare and the flux of technology.

    abstract::For Medinfo '98, as an exercise in technological forecasting and analysis, we volunteered to project the direction of healthcare informatics into the next century. This paper is an extended discussion of that presentation. We open with the observation that healthcare informatics is merely one of the many endeavors tha...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/s1386-5056(98)00161-0

    authors: Lincoln TL,Builder C

    更新日期:1999-02-01 00:00:00

  • Information quality of a Nursing Information System depends on the nurses: a combined quantitative and qualitative evaluation.

    abstract:PURPOSE:Providing access to patient information is the key factor in nurses' adoption of a Nursing Information System (NIS). In this study the requirements for information quality and the perceived quality of information are investigated. A teaching hospital in the Netherlands has developed a NIS as a module of the Hos...

    journal_title:International journal of medical informatics

    pub_type: 杂志文章

    doi:10.1016/j.ijmedinf.2012.07.006

    authors: Michel-Verkerke MB

    更新日期:2012-10-01 00:00:00