Modelo de avaliação econômica para atividades de telemedicina hospitalar

Abstract

The health sector suffers from a shortage of financial resources and qualified health professionals. These factors can make it unfeasible to provide agile and adequate health services for primary prevention, chronic disease control, and good diagnosis. Challenges such as technology, population aging, new diseases, and a greater active perception of the patient lead to the need for transformation in the management of healthcare providers. Telemedicine is proposed as a useful tool to increase efficiency, improve access and quality of care. However, the lack of evidence of cost-effectiveness in telemedicine programs becomes one of the main barriers to their application, particularly in developing countries. The objective of this research is to suggest an economic evaluation model for hospital telemedicine activities. The work method adopted to conduct this research was Design Science Research, relating six phases of the method to the specific objectives of this research. The research has a methodological approach, in which data collection is done by analyzing existing assessments in the literature. Cost and consequence indicators were listed to recommend the evaluation model, based on the understanding of the results achieved by the authors of the studies considered in the scoping review. The model was built presenting the necessary elements for implementation, focusing its structure on the basic elements of an economic evaluation in the context of telemedicine, effectiveness, and cost. The cost-effectiveness assessment was indicated. For the cost indicators, direct and indirect costs of the health institution were identified, comprising costs with communication service, training, single capital, staff, companion, supply and medication, medical equipment, patient travel, parking, food, management of the program, hospitalization, medical examination, medical procedure, medical diagnosis, telemedicine program in general, emergency care, rent, electricity, and water, waiting for care and loss of patient productivity at work, supported by the ABC costing method for their measurement. To measure effectiveness, the indicators of consequence were identified as complications in treatment, mortality, patient disability, hospital discharge, hospital readmission, treatment time, medical staff workload, patient satisfaction, waiting time for treatment, number of visits, rate of treatment adherence, punctuality in attendance, number of exams and probability of diagnosis. A theoretical survey covering all indicators was developed with their basic applications. From this study, standardized information is obtained to economically evaluate hospital telemedicine programs, providing their correct use. In this way, the contributions are made in the scientific context, in which it promotes a new vision of uniting the results of specific elements for a common objective and, in the practical context, in which its complete application can help in an efficient allocation of resources, minimizing costs of opportunity, and thus facilitating the application of such an important technology, telemedicine.