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Cost Analysis of an Outpatient MRI Pathway for Optic Disc Edema: A Time-Driven Activity-Based Costing Approach
Florian H Guillot1, James Davis2, Divya Manikandan3
1From the Division of Neuro-Ophthalmology (F.H.G., J.D., J.B., M.G.C., A.R.C., A.D.H.), Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA; Casey Eye Institute (F.H.G.), Oregon Health & Science University, Portland, Oregon, USA.
An outpatient STAT neuroimaging pathway offers significant cost and time savings for patients with optic disc edema compared to traditional emergency department (ED) care. This expedited neuroimaging approach reduces overall healthcare expenses and patient wait times.
Area of Science:
- Ophthalmology
- Radiology
- Health Economics
Background:
- Optic disc edema diagnosis requires timely neuroimaging.
- Traditional emergency department (ED) pathways can be costly and time-consuming.
- Optimizing neuroimaging workflows is crucial for efficient patient care.
Purpose of the Study:
- To compare the costs and efficiency of an outpatient STAT neuroimaging pathway versus traditional ED-based neuroimaging for optic disc edema.
- To evaluate the impact of a dedicated outpatient pathway on healthcare resource utilization.
Main Methods:
- Retrospective cost analysis utilizing time-driven activity-based costing (TDABC) methodology.
- Involved 129 patients with optic disc edema undergoing neuroimaging.
- Compared dedicated outpatient STAT pathway (implemented Nov 2020) with ED pathway using process mapping and electronic health record data.
Main Results:
- The outpatient STAT pathway was significantly less costly (median $285 vs. $355 per patient, p<0.001), representing a 20% cost reduction.
- Personnel and facilities costs were primary drivers of savings in the STAT pathway.
- Median imaging visit duration was 70% shorter in the STAT pathway (1.93 hours vs. 6.47 hours, p<0.001).
Conclusions:
- Outpatient STAT neuroimaging is a cost- and time-effective alternative for select patients with optic disc edema.
- TDABC methodology provided an unbiased assessment of healthcare costs.
- Process mapping and TDABC offer a framework to optimize care pathways, reduce costs, and decrease ED burden.
