title: Cost-benefit analysis of telehealth in pre-hospital care.
abstract: Objective There has been very little use of telehealth in pre-hospital emergency medical services (EMS), yet the potential exists for this technology to transform the current delivery model. In this study, we explore the costs and benefits of one large telehealth EMS initiative. Methods Using a case-control study design and both micro- and gross-costing data from the Houston Fire Department EMS electronic patient care record system, we conducted a cost-benefit analysis (CBA) comparing costs with potential savings associated with patients treated through a telehealth-enabled intervention. The intervention consisted of telehealth-based consultation between the 911 patient and an EMS physician, to evaluate and triage the necessity for patient transport to a hospital emergency department (ED). Patients with non-urgent, primary care-related conditions were then scheduled and transported by alternative means to an affiliated primary care clinic. We measured CBA as both total cost savings and cost per ED visit averted, in US Dollars ($USD). Results In total, 5570 patients were treated over the first full 12 months with a telehealth-enabled care model. We found a 6.7% absolute reduction in potentially medically unnecessary ED visits, and a 44-minute reduction in total ambulance back-in-service times. The average cost for a telehealth patient was $167, which was a statistically significantly $103 less than the control group ( p < .0001). The programme produced a $928,000 annual cost savings from the societal perspective, or $2468 cost savings per ED visit averted (benefit). Conclusion Patient care enabled by telehealth in a pre-hospital environment, is a more cost effective alternative compared to the traditional EMS 'treat and transport to ED' model.
authors.affiliation: 1 School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Langabeer
authors.affiliation: 1 School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Champagne-Langabeer
authors.affiliation: 1 School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA.|2 Houston Fire Department Emergency Medical Services, Houston, TX, USA.
authors.forename: Diaa
authors.initials: D
authors.lastname: Alqusairi
authors.affiliation: 1 School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Junghyun
authors.initials: J
authors.lastname: Kim
authors.affiliation: 3 City of Houston Health Department, Houston, TX, USA.
authors.forename: Adria
authors.initials: A
authors.lastname: Jackson
authors.affiliation: 2 Houston Fire Department Emergency Medical Services, Houston, TX, USA.
authors.forename: David
authors.initials: D
authors.lastname: Persse
authors.affiliation: 2 Houston Fire Department Emergency Medical Services, Houston, TX, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Gonzalez
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D004632:Emergency Medical Services / Q000191:economics / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D019114:Remote Consultation / Q000191:economics / Q000458:organization & administration*; D013781:Texas; D014218:Triage / Q000379:methods
keywords: Cost–benefit analysis; emergency medical services; pre-hospital care; telehealth