An evaluation of a digital pain management programme: clinical effectiveness and cost savings

Introduction: Chronic pain is one of the most prevalent causes of disability worldwide, and digital interventions may be one of the ways to meet this need. Randomised controlled trials have demonstrated that digital interventions can be effective in treating chronic pain. This study aimed to establish the clinical effectiveness of a web-based pain management programme (PMP), specifically whether it would lead to improved clinical outcomes and reduced health care costs in a real-world clinical setting. Methods: Of 738 participants, 438 engaged with the programme and 300 did not. Two analyses were conducted: a within-subjects pre–post comparison of clinical outcomes for participants who completed the programme and a between-groups comparison of health care usage for those who engaged and those who did not. Results: Participants who completed the programme made significant improvements with regard to their perceived health status, level of disability, mood, confidence managing pain, problems in life due to pain and level of pain. Around one-third of participants made reliable changes in their levels of disability, depression and anxiety. There was no relationship between gender or age and engagement with the programme. Those who engaged with the programme demonstrated reduced health care costs in the year following referral, whereas health care costs of non-engagers increased. Limitations of the study include a high drop-out rate and a non-randomised comparison group. Results must therefore be interpreted with some caution. Conclusion: A web-based pain management programme can be clinically effective and may be a useful addition to the treatments offered by pain management services.

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Opioid-Related Adverse Events: Incidence and Impact in Patients Undergoing Cardiac Surgery

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253219888658 ◽

2019 ◽

Vol 24 (3) ◽

pp. 219-226 ◽

Cited By ~ 5

Author(s):

Keith B. Allen ◽

Ethan Y. Brovman ◽

Adnan K. Chhatriwalla ◽

Katherine J. Greco ◽

Nikhilesh Rao ◽

...

Keyword(s):

Health Care ◽

Cardiac Surgery ◽

Pain Management ◽

Length Of Stay ◽

Health Care Costs ◽

Adverse Drug Events ◽

Management Strategies ◽

Coronary Bypass ◽

Administrative Claims ◽

Care Costs

Purpose. Opioid-related adverse drug events (ORADEs) increase patient length of stay (LOS) and health care costs. However, ORADE rates may be underreported. This study attempts to understand the degree to which ORADEs are underreported in Medicare patients undergoing cardiac surgery. Materials and Methods. The Center for Medicare and Medicaid Services administrative claims database was used to identify ORADEs in 110 158 Medicare beneficiaries who underwent cardiac valve (n = 50 525) or coronary bypass (n = 59 633) surgery between April 2016 and March 2017. The International Classification of Disease (ICD)-10 codes specifically linked to ORADEs were used to identify an actual ORADE rate, while additional ICD codes, clinically associated with butas not specific to adverse drug events were analyzed as potential ORADEs. Length of stay (LOS) and hospital daily revenue were analyzed among patients with or without a potential ORADE. Results. Among patients undergoing valve or bypass surgery, the documented ORADE rate was 0.7% (743/110 158). However, potential ORADEs may have occurred in up to 32.4% (35 658/110 158) of patients. In patients with a potential ORADE, mean LOS was longer (11.4 vs 8.2 days; P < .0001) and mean Medicare revenue/day was lower ($4016 vs $4412; P < .0001). The mean net difference in revenue/day between patients with and without an ORADE varied between $231 and $1145, depending on the Diagnosis-Related Group analyzed. Conclusions. ORADEs are likely underreported following cardiac surgery. ORADEs can be associated with increased LOS and decreased hospital revenue. Understanding the incidence and economic impact of ORADEs may expedite changes to postoperative pain management. Adopting multimodal pain management strategies that reduce exposure to opioids may improve outcomes by reducing complications, side effects, and health care costs.

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Incremental health care costs for chronic pain in Ontario, Canada—what in the pain are we counting?

Pain ◽

10.1097/j.pain.0000000000000619 ◽

2016 ◽

Vol 157 (8) ◽

pp. 1833-1834

Author(s):

V.Tonelli Enrico

Keyword(s):

Health Care ◽

Chronic Pain ◽

Health Care Costs ◽

Care Costs

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Health care costs, work productivity and activity impairment in non-malignant chronic pain patients

The European Journal of Health Economics ◽

10.1007/s10198-008-0096-3 ◽

2008 ◽

Vol 10 (1) ◽

pp. 5-13 ◽

Cited By ~ 41

Author(s):

Christian Kronborg ◽

Gitte Handberg ◽

Flemming Axelsen

Keyword(s):

Health Care ◽

Chronic Pain ◽

Health Care Costs ◽

Work Productivity ◽

Activity Impairment ◽

Chronic Pain Patients ◽

Care Costs ◽

Pain Patients

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Incremental health care costs for chronic pain in Ontario, Canada

Pain ◽

10.1097/j.pain.0000000000000561 ◽

2016 ◽

Vol 157 (8) ◽

pp. 1626-1633 ◽

Cited By ~ 34

Author(s):

Mary-Ellen Hogan ◽

Anna Taddio ◽

Joel Katz ◽

Vibhuti Shah ◽

Murray Krahn

Keyword(s):

Health Care ◽

Chronic Pain ◽

Health Care Costs ◽

Care Costs

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Health Care Costs And Clinical Outcomes Associated With Rates Of Sulfonylurea Use By Physicians

Value in Health ◽

10.1016/j.jval.2013.03.869 ◽

2013 ◽

Vol 16 (3) ◽

pp. A173-A174

Author(s):

K. Bognar ◽

K. Bell ◽

D.N. Lakdawalla ◽

A. Shrestha ◽

J.T. Snider ◽

...

Keyword(s):

Health Care ◽

Clinical Outcomes ◽

Health Care Costs ◽

Care Costs

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Hospital readmissions after discharge to home with the Total Artificial Heart Freedom driver: Readmission reasons, clinical outcomes, and health care costs

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2015.10.031 ◽

2016 ◽

Vol 35 (2) ◽

pp. 251-252 ◽

Cited By ~ 5

Author(s):

Mohammed A. Quader ◽

Andrew J. Green ◽

Keyur B. Shah ◽

Richard Cooke ◽

Vigneshwar Kasirajan

Keyword(s):

Health Care ◽

Clinical Outcomes ◽

Health Care Costs ◽

Artificial Heart ◽

Hospital Readmissions ◽

Total Artificial Heart ◽

Care Costs

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Implementation of a Digitally Enabled Care Pathway (Part 1): Impact on Clinical Outcomes and Associated Health Care Costs

Journal of Medical Internet Research ◽

10.2196/13147 ◽

2019 ◽

Vol 21 (7) ◽

pp. e13147 ◽

Cited By ~ 6

Author(s):

Alistair Connell ◽

Rosalind Raine ◽

Peter Martin ◽

Estela Capelas Barbosa ◽

Stephen Morris ◽

...

Keyword(s):

Health Care ◽

Cardiac Arrest ◽

Clinical Outcomes ◽

Health Care Costs ◽

Primary Outcome ◽

Care Pathway ◽

Hospitalized Patients ◽

Intervention Site ◽

Arrest Rate ◽

Care Costs

Background The development of acute kidney injury (AKI) in hospitalized patients is associated with adverse outcomes and increased health care costs. Simple automated e-alerts indicating its presence do not appear to improve outcomes, perhaps because of a lack of explicitly defined integration with a clinical response. Objective We sought to test this hypothesis by evaluating the impact of a digitally enabled intervention on clinical outcomes and health care costs associated with AKI in hospitalized patients. Methods We developed a care pathway comprising automated AKI detection, mobile clinician notification, in-app triage, and a protocolized specialist clinical response. We evaluated its impact by comparing data from pre- and postimplementation phases (May 2016 to January 2017 and May to September 2017, respectively) at the intervention site and another site not receiving the intervention. Clinical outcomes were analyzed using segmented regression analysis. The primary outcome was recovery of renal function to ≤120% of baseline by hospital discharge. Secondary clinical outcomes were mortality within 30 days of alert, progression of AKI stage, transfer to renal/intensive care units, hospital re-admission within 30 days of discharge, dependence on renal replacement therapy 30 days after discharge, and hospital-wide cardiac arrest rate. Time taken for specialist review of AKI alerts was measured. Impact on health care costs as defined by Patient-Level Information and Costing System data was evaluated using difference-in-differences (DID) analysis. Results The median time to AKI alert review by a specialist was 14.0 min (interquartile range 1.0-60.0 min). There was no impact on the primary outcome (estimated odds ratio [OR] 1.00, 95% CI 0.58-1.71; P=.99). Although the hospital-wide cardiac arrest rate fell significantly at the intervention site (OR 0.55, 95% CI 0.38-0.76; P<.001), DID analysis with the comparator site was not significant (OR 1.13, 95% CI 0.63-1.99; P=.69). There was no impact on other secondary clinical outcomes. Mean health care costs per patient were reduced by £2123 (95% CI −£4024 to −£222; P=.03), not including costs of providing the technology. Conclusions The digitally enabled clinical intervention to detect and treat AKI in hospitalized patients reduced health care costs and possibly reduced cardiac arrest rates. Its impact on other clinical outcomes and identification of the active components of the pathway requires clarification through evaluation across multiple sites.

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