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© 2022. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Objectives

The aim of this study was: (1) to adapt the time‐driven activity‐based costing (TDABC) method to emergency department (ED) ambulatory care; (2) to estimate the cost of care associated with frequently encountered ambulatory conditions; and (3) to compare costs calculated using estimated time and objectively measured time.

Methods

TDABC was applied to a retrospective cohort of patients with upper respiratory tract infections, urinary tract infections, unspecified abdominal pain, lower back pain and limb lacerations who visited an ED in Québec City (Canada) during fiscal year 2015–2016. The calculated cost of care was the product of the time required to complete each care procedure and the cost per minute of each human resource or equipment involved. Costing based on durations estimated by care professionals were compared to those based on objective measurements in the field.

Results

Overall, 220 care episodes were included and 3080 time measurements of 75 different processes were collected. Differences between costs calculated using estimated and measured times were statistically significant for all conditions except lower back pain and ranged from $4.30 to $55.20 (US) per episode. Differences were larger for conditions requiring more advanced procedures, such as imaging or the attention of ED professionals.

Conclusions

The greater the use of advanced procedures or the involvement of ED professionals in the care, the greater is the discrepancy between estimated‐time‐based and measured‐time‐based costing. TDABC should be applied using objective measurement of the time per procedure.

Details

Title
Adaptation of time‐driven activity‐based costing to the evaluation of the efficiency of ambulatory care provided in the emergency department
Author
Berthelot, Simon 1 ; Mallet, Myriam 2 ; Blais, Sébastien 2 ; Moore, Lynne 3 ; Guertin, Jason R 3 ; Boulet, Justine 2 ; Boilard, Christian 2 ; Fortier, Camille 2 ; Huard, Benoît 2 ; Mokhtari, Akram 2 ; Lesage, Annika 2 ; Lévesque, Émilie 2 ; Baril, Laurence 1 ; Olivier, Pascale 2 ; Vachon, Keven 2 ; Yip, Olivia 2 ; Bouchard, Mathieu 2 ; Simonyan, David 2 ; Létourneau, Mélanie 2 ; Pineault, Amélie 2 ; Vézo, Adrien 2 ; Stelfox, Henry T 4 

 CHU de Québec‐Université Laval, Québec, Canada; Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Québec, Canada 
 CHU de Québec‐Université Laval, Québec, Canada 
 CHU de Québec‐Université Laval, Québec, Canada; Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Canada 
 Department of Critical Care and the O'Brien Institute for Public Health, McCaig Tower, University of Calgary, Calgary, Alberta, Canada 
Section
Health Policy
Publication year
2022
Publication date
Aug 2022
Publisher
John Wiley & Sons, Inc.
e-ISSN
26881152
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2707522422
Copyright
© 2022. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.