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).
BACKGROUND
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.
Elkin
Peter L
PL
Center for Biomedical Informatics, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1023, New York, NY 10029, USA. peter.elkin@mssm.edu
Liebow
Mark
M
Bauer
Brent A
BA
Chaliki
Swarna
S
Wahner-Roedler
Dietlind
D
Bundrick
John
J
Lee
Mark
M
Brown
Steven H
SH
Froehling
David
D
Bailey
Kent
K
Famiglietti
Kathleen
K
Kim
Richard
R
Hoffer
Ed
E
Feldman
Mitchell
M
Barnett
G Octo
GO
D003362:Cost-Benefit Analysis; D020000:Decision Support Systems, Clinical / Q000191:economics*; D003936:Diagnosis, Computer-Assisted / Q000191:economics*; D003953:Diagnosis-Related Groups / Q000191:economics*; D006784:Hospitals, Teaching / Q000191:economics*; D006801:Humans; D057188:Workflow