title: Costs of multidisciplinary parenteral nutrition care provided at a distance via mobile tablets.
abstract: BACKGROUND
  Determining the costs of healthcare delivery is a key step for providing efficient nutrition-based care. This analysis tabulates the costs of delivering home parenteral nutrition (HPN) interventions and clinical assessments through encrypted mobile technologies to increase patients' access to healthcare providers, reduce their travel expenses, and allow early detection of infection and other complications.
  
  
  METHODS
  A traditional cost-accounting method was used to tabulate all expenses related to mobile distance HPN clinic appointments, including (1) personnel time of multidisciplinary healthcare professionals, (2) supply of HPN intervention materials, and (3) equipment, connection, and delivery expenses.
  
  
  RESULTS
  A total of 20 mobile distance clinic appointments were conducted for an average of 56 minutes each with 45 patients who required HPN infusion care. The initial setup costs included mobile tablet devices, 4G data plans, and personnel's time as well as intervention materials. The initial costs were on average $916.64 per patient, while the follow-up clinic appointments required $361.63 a month, with these costs continuing to decline as the equipment was used by multiple patients more frequently over time. Patients reported high levels of satisfaction with cost savings in travel expenses and rated the quality of care comparable to traditional in-person examinations.
  
  
  CONCLUSIONS
  This study provides important aspects of the initial cost tabulation for visual assessment for HPN appointments. These findings will be used to generate a decision algorithm for scheduling mobile distance clinic appointments intermittent with in-person visits to determine how to lower costs of nutrition assessments. To maximize the cost benefits, clinical trials must continue to collect clinical outcomes.
authors.affiliation: University of Kansas School of Nursing, Kansas City, Kansas hkim2@kumc.edu.
authors.forename: Heejung
authors.initials: H
authors.lastname: Kim
authors.affiliation: University of Kansas School of Medicine, Kansas City, Kansas.
authors.forename: Ryan
authors.initials: R
authors.lastname: Spaulding
authors.affiliation: University of Kansas School of Nursing, Kansas City, Kansas.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Werkowitch
authors.affiliation: University of Kansas School of Nursing, Kansas City, Kansas.
authors.forename: Donna
authors.initials: D
authors.lastname: Yadrich
authors.affiliation: University of Kansas School of Nursing, Kansas City, Kansas.
authors.forename: Ubolrat
authors.initials: U
authors.lastname: Piamjariyakul
authors.affiliation: University of Kansas School of Medicine, Kansas City, Kansas.
authors.forename: Richard
authors.initials: R
authors.lastname: Gilroy
authors.affiliation: University of Kansas School of Nursing and Preventive Medicine & Public Health, Kansas City, Kansas.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Smith
mesh_terms: D003201:Computers / Q000191:economics*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D005102:Health Expenditures; D006295:Health Resources / Q000191:economics; D006801:Humans; D016331:Parenteral Nutrition, Home / Q000191:economics*; D010289:Parenteral Nutrition, Total / Q000191:economics; D017060:Patient Satisfaction; D011787:Quality of Health Care; D013607:Tablets; D017216:Telemedicine / Q000191:economics*; D014195:Travel / Q000191:economics
chemical_list: D013607:Tablets
keywords: home nutrition support; nutrition; nutrition support practice; outcomes research/quality; parenteral nutrition; reimbursement