Abstract
ObjectiveThis study analyzed cost of implementing computer-assisted Clinical Decision Support System (CDSS) in selected health care centres in Ghana.MethodsA descriptive cross sectional study was conducted in the Kassena-Nankana district (KND). CDSS was deployed in selected health centres in KND as an intervention to manage patients attending antenatal clinics and the labour ward. The CDSS users were mainly nurses who were trained. Activities and associated costs involved in the implementation of CDSS (pre-intervention and intervention) were collected for the period between 2009–2013 from the provider perspective. The ingredients approach was used for the cost analysis. Costs were grouped into personnel, trainings, overheads (recurrent costs) and equipment costs (capital cost). We calculated cost without annualizing capital cost to represent financial cost and cost with annualizing capital costs to represent economic cost.ResultsTwenty-two trained CDSS users (at least 2 users per health centre) participated in the study. Between April 2012 and March 2013, users managed 5,595 antenatal clients and 872 labour clients using the CDSS. We observed a decrease in the proportion of complications during delivery (pre-intervention 10.74% versus post-intervention 9.64%) and a reduction in the number of maternal deaths (pre-intervention 4 deaths versus post-intervention 1 death). The overall financial cost of CDSS implementation was US$23,316, approximately US$1,060 per CDSS user trained. Of the total cost of implementation, 48% (US$11,272) was pre-intervention cost and intervention cost was 52% (US$12,044). Equipment costs accounted for the largest proportion of financial cost: 34% (US$7,917). When economic cost was considered, total cost of implementation was US$17,128–lower than the financial cost by 26.5%.ConclusionsThe study provides useful information in the implementation of CDSS at health facilities to enhance health workers' adherence to practice guidelines and taking accurate decisions to improve maternal health care.
Highlights
The widely used approach to improve the skills of health workers and the quality of health service provision is the use of clinical decision support systems [1,2,3]
In the light of this, most African countries adopted the WHO guidelines on Pregnancy, Childbirth, Postpartum and Newborn Care (PCPNC) [7] to support health workers in clinical decision making for the improvement of quality of maternal and neonatal care (MNC)
This study describes the activities and the cost of a computer-assisted Clinical Decision Support System (CDSS) implementation in the Kassena-Nakana district of northern Ghana to provide estimates that may be useful in guiding other initiatives for computer-assisted CDSS implementation
Summary
The widely used approach to improve the skills of health workers and the quality of health service provision is the use of clinical decision support systems [1,2,3]. In Kassena-Nankana District of Northern Ghana (KND), the paper based WHO PCPNC guideline is poorly used and followed by health workers [2]. This limits the quality of antenatal and delivery care in the district [8]. In 2012 as an alternative to the paper based WHO PCPNC guideline, Navrongo Health Research Centre introduced a computer-assisted Clinical Decision Support System (CDSS) in the district. This initiative was within the frame of maternal and neonatal care research project-QUALMATfunded by the 7th Framework programme of the European Union. Several studies have shown that computer-assisted CDSS helps in the application of knowledge more effectively and as a result improves provider performance and health care quality [4,10,11,12,13,14]
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