title: Transaction cost analysis of in-clinic versus telehealth consultations for chronic pain: preliminary evidence for rapid and affordable access to interdisciplinary collaborative consultation.
abstract: OBJECTIVE
  With ever increasing mandates to reduce costs and increase the quality of pain management, health care institutions are faced with the challenge of adopting innovative technologies and shifting workflows to provide value-based care. Transaction cost economic analysis can provide comparative evaluation of the consequences of these changes in the delivery of care. The aim of this study was to establish proof-of-concept using transaction cost analysis to examine chronic pain management in-clinic and through telehealth.
  
  
  METHODS
  Participating health care providers were asked to identify and describe two comparable completed transactions for patients with chronic pain: one consultation between patient and specialist in-clinic and the other a telehealth presentation of a patient's case by the primary care provider to a team of pain medicine specialists. Each provider completed two on-site interviews. Focus was on the time, value of time, and labor costs per transaction. Number of steps, time, and costs for providers and patients were identified.
  
  
  RESULTS
  Forty-six discrete steps were taken for the in-clinic transaction, and 27 steps were taken for the telehealth transaction. Although similar in costs per patient ($332.89 in-clinic vs. $376.48 telehealth), the costs accrued over 153 business days in-clinic and 4 business days for telehealth. Time elapsed between referral and completion of initial consultation was 72 days in-clinic, 4 days for telehealth.
  
  
  CONCLUSIONS
  U.S. health care is moving toward the use of more technologies and practices, and the information provided by transaction cost analyses of care delivery for pain management will be important to determine actual cost savings and benefits.
authors.affiliation: Department of Anesthesiology and Pain Medicine.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Theodore
authors.affiliation: Urban Design and Planning.
authors.forename: Jan
authors.initials: J
authors.lastname: Whittington
authors.affiliation: School of Medicine.
authors.forename: Cara
authors.initials: C
authors.lastname: Towle
authors.affiliation: Department of Anesthesiology and Pain Medicine.
authors.forename: David J
authors.initials: DJ
authors.lastname: Tauben
authors.affiliation: Center for Information Assurance and Cybersecurity.
authors.forename: Barbara
authors.initials: B
authors.lastname: Endicott-Popovsky
authors.affiliation: Department of Anesthesiology and Pain Medicine.
authors.forename: Alex
authors.initials: A
authors.lastname: Cahana
authors.affiliation: Department of Anesthesiology and Pain Medicine.|Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA.
authors.forename: Ardith Z
authors.initials: AZ
authors.lastname: Doorenbos
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D003299:Cooperative Behavior; D003365:Costs and Cost Analysis / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018710:Pain Clinics / Q000191:economics*; D059408:Pain Management / Q000191:economics / Q000379:methods; D010348:Patient Care Team / Q000191:economics*; D012017:Referral and Consultation / Q000191:economics*; D017216:Telemedicine / Q000191:economics* / Q000379:methods; D013997:Time Factors
keywords: Chronic Pain; Cost-Benefit; Economics; Telehealth; Transaction Cost; Triple Aim