耳鳴りインプラントケアの最適化：聴覚士および耳鼻咽喉科医のワークフローの時間駆動型活動基準コスト計算（TDABC）分析

科学分野:

• Otolaryngology
• Audiology
• Health Services Research

背景:

• Cochlear implants (CIs) are effective hearing restoration devices, yet access remains limited for eligible US adults, particularly due to socioeconomic disparities.
• Understanding the time and cost associated with CI care delivery is crucial for optimizing patient access and supporting healthcare professionals.
• Current CI care pathways involve multiple preoperative and postoperative appointments, with significant time investment from clinical staff.

研究 の 目的:

• To quantify the personnel time and associated costs for the complete preoperative and postoperative cochlear implant (CI) care pathway.
• To identify specific areas within the CI care process that are time-intensive and present opportunities for workflow optimization.
• To explore potential strategies for enhanced audiologist support to improve efficiency and patient access.

主な方法:

• A multi-institutional time-driven activity-based costing (TDABC) analysis was employed.
• Direct observation was used to capture time requirements for standard CI care pathways at two academic tertiary neurotology centers.
• Personnel costs were calculated using national salary data.

主要な成果:

• The entire CI care pathway required 397.5 minutes (6.6 hours) of direct clinician time, costing $316.65 in personnel expenses.
• Audiology services represented 80% ($254.45) of the total costs and 361 minutes of the total time.
• Preoperative audiology evaluations alone accounted for 2.6 hours, with significant time variations observed across different visit types.

結論:

• Audiologists dedicate substantial direct patient care time (nearly 6 hours) per CI recipient during the perioperative period, constituting the majority of personnel costs.
• Significant variations in visit durations highlight opportunities for standardizing CI care processes.
• Implementing administrative support, streamlined documentation, and optimized scheduling for audiologists can enhance clinician satisfaction and improve patient access to cochlear implants.