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A Cost-Effectiveness Analysis of a Multimedia Learning Education Programs for Stoma Patients

Tzu Chi College of Technology National Taiwan University. A Cost-Effectiveness Analysis of a Multimedia Learning Education Programs for Stoma Patients.

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A Cost-Effectiveness Analysis of a Multimedia Learning Education Programs for Stoma Patients

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  1. Tzu Chi College of TechnologyNational Taiwan University A Cost-Effectiveness Analysis of aMultimedia Learning Education ProgramsforStoma Patients Shu-Fen LoRN,MSN, Instructor, Department of Nursing ,Tzu Chi College of Technology & Doctoral Student, Graduate Institute of Nursing National Taiwan University

  2. Why do we need the relevance of economic evaluation? Body disfigurement, leakage, skin problems, and odor Physical impacts Lifestyle restrictions fear of leakage Colon Ca top 3 Social impacts Psychological impacts Quality of care=Quality of life

  3. Why do we need the relevance of economic evaluation? • 8 internationally certified enterostomal therapists • No comprehensives training programs Colon Ca Patients Staff burden(1:8-10) NHI* payment  Quality of care ≠ Quality of life Note:*National Health Insurance (NHI)

  4. Why do we need the relevance of economic evaluation? • 8 internationally certified enterostomal therapists NHI* payment  • No comprehensives training programs Colon Ca Patients Staff burden(1:8-10) Quality of care = Quality of life Provide patients information Staff burden MLEP  knowledge of illness Family burden

  5. We want to do…….. • To evaluate that MLEP was more or less costly than CESP* • To get the CE** ratios of MLEP and CESP. • Hypothesized • Each patient in MLEP (intervention group) • Spend less care costs • Have more knowledge • Positive attitudes • Better self-care behaviors Note: * CESP: Conventional Education Service Program **CE ratio: cost-effectiveness ratio

  6. Table1.The Conceptual CEA in MLEP and CESP withStoma patients Note: CEA: Cost and Effectiveness Analysis; MLEP: Multimedia Learning Education Program; CESP: Conventional Education Service Program ;P: Participant;; NP: Non- Participant ;S: Society; KSC: knowledge of self-care ;ASC: Attitude of self-care; BSC: Behavior of Self-Care; +: positive value; +/0: positive value/ zero; 0: zero Boardman A. et al. Cost-Benefit Analysis: Concepts and Practice, NJ: Prentice-Hall, 1996: 258– 60, 395-402. Gramlich EM.A Guide to Benefit-cost Analysis, 2nd edition. NJ: Prentice-Hall, 1990: 150–70.

  7. Materials and Methods • selection criteria included • Stoma patient admitted to the surgical unit • 18 years or older • speak and read Chinese. • Tzu Chi Medical Center’s IRB • Data collection was performed by one researcher

  8. Materials and Methods • MLEP intervention • Type of stoma • Anatomy • Indications • Stoma care • Irrigation with post-surgery • 30-45 minutes Multimedia Learning Education Programs (Kao& Ku,1997; Su, Dai, Chang, &KP,2001)

  9. Total Stoma from February to November 2006 (n=68) Assessed for eligibility (n=60) Excluded (n=3) Did not meet inclusion criteria (n=2) Refused to participate (n=1) Enrollment Randomly assigned (n=54) MLEP group (n=27) CESP group (n=27)

  10. Reliability & Validity Note: KSC: knowledge of self-care ;ASC: Attitude of self-care; BSC: Behavior of Self-Care

  11. Statistical analysis • SPSS 14.0 to do statistical analysis. • A p value < .05. was deemed statistically significant. • Cost were converted to US dollars (e.g. US$1= NT$ 32.53)

  12. Results • 54 patients enrolled( MLEP=27;CESP=27) • Ages ranged from 18 to 90 years • Ages mean was 60.44 years (SD=17.60). • 63% received elementary school or below education • 57% were male • Fifty-two percent were married • 80% were living with families. • 72% not employed • 48.2%physical status was acceptable or good • No significant difference in demographic variables between two groups.

  13. Table1.Cost and Effectiveness Analysis between two groups (unit: per person)

  14. Table2.Cost and Effectiveness Analysis between two groups

  15. Table 3. Comparison of main outcome variables between MLEP and CESP Groups＊ ＊ The numbers in this table are all original scores.

  16. Table2.Cost and Effectiveness Analysis between two groups

  17. Table4. Sensitivity Analysis of MLEP and CESP Groups in totally 5 years (N=54) Note:MLEP: [=US$7941.71+ (US$7941.71- US$0.92- US$565.76- US$0.17) × 5] CESP: [=US$8570.54 × 6].Total Effectiveness Scores:1000.62 (=166.77 × 6) and 665.34 (=110.89 × 6)

  18. Discussion • 8 internationally certified enterostomal therapists NHI* payment  • No comprehensives training programs Colon Ca Patients Staff burden(1:8-10) Quality of care = Quality of life Greater cost-effectiveness Cost MLEP one week  KSC,ASC, and BSC Family burden

  19. Key points • Using MLEP to educate individuals with stoma provides a cost savings • The family burden in MLEP was less costly than that in CESP • The MLEP group is significantly higher level of KSC,ASC, and BSC

  20. Thank you for your attention Taiwan

  21. References • Department of Health, Executive Yuan, Taiwan, R.O.C. The prevalence and number of patients of top ten tumors in Taiwan, 2005. Taipei: Department of Health, Executive Yuan, Taiwan. • Walling AD. Multidimensional care of patients with stoma. Am Fam Physician 2004; 69: 193-4. • Karadag A, Mentes BB, Üner A, Irkörücü O, Sultan A, Seçil Ö. Impact of stoma therapy on quality of life in patients with permanent colostomies or ileostomies. Int J Colorectal Dis 2003;18:234-40. • Tseng HC, Wang HH, Hsu YY, Weng WC. Factors related to stress in outpatients with permanent colostomies. Kaohsiung J Med Sci 2004; 20: 70-7. • Lin LY, Hsu HC. A study of knowledge and attitudes toward stoma care among nurses. In: 16th biennial congress of the World Council of Enterostomal Therapists, 2006, Hong Kong. World Council of Enterostomal Therapists Congress Series No A70 .Hong Kong: Concurrent session 17 education 2006:102 .[Abstract] • Su HR (1993). The study of job stressors and stress response of clinical nurses. J Nurs Res 1993; 1: 83-93. • Yang KP, Huang CK. The effects of staff nurses' morale on patient satisfaction. J Nurs Res 2005;13 : 141-52. • Lo SF. The effectiveness of MELPs on knowledge, axiety, and rehabilitation compliance behavior of patients with surgicals: A pilot study. In: 16th biennial congress of the World Council of Enterostomal Therapists, 2006, Hong Kong. World Council of Enterostomal Therapists Congress Series No A170 .Hong Kong: Concurrent session 12 wound care 2006:80 .[Abstract] • Lo SF, Wu LY, Hsu MY, Chang SC. The effects of multi-media intervention on patients with stomain Taiwan: A pilot study. In: 16th biennial congress of the World Council of Enterostomal Therapists, 2006, Hong Kong. World Council of Enterostomal Therapists Congress Series No A176 .Hong Kong: Concurrent session 17 education 2006:102 .[Abstract] • Caban A, Cimino C, Swencionis C, Ginsberg M, Wylie-Rosett J. Estimating software development costs for a patient multimedia education project. J Am Med Inform Assoc 2001;8: 185-88.

  22. References • Issenberg SB, Gordon MS, Greber AA. Bedside cardiology skills training for the osteopathic internist using simulation technology. J Am Osteopath Assoc 2003; 12: 603-7. • Hutton, G. (2001). Considerations in evaluating the cost effectiveness of environmental health interventions. OCT,29,2006, Available at :http://www.who.int/quantifying_ehimpacts/cost_effectiveness/wsh0010/en/index.html. • Allred CA , Arford PH, Mauldin PD, Goodwin L K. Cost-effectiveness analysis in the nursing literature, 1992-1996. Image J Nurs Sch 1998; 30: 235. • Paperny DM, Hedberg VA (1999). Computer-assisted health counselor visits: A low-cost model for comprehensive adolescent preventive services. Archives of pediatrics & adolescent medicine 1999; 153 : 63-7. • Boardman A. et al. Cost-Benefit Analysis: Concepts and Practice, NJ: Prentice-Hall, 1996: 258– 60, 395-402. • Gramlich EM.A Guide to Benefit-cost Analysis, 2nd edition. NJ: Prentice-Hall, 1990: 150–70. • Chaudhri S, Brown L, Hassan I. Preoperative intensive, community-based vs. traditional stoma education: A randomized, controlled trial. Dis Colon Rectum 2005; 48: 504-9. • Nijboer C, Triemstra M, Tempelaar R, Mulder MS, Robbert Van den, Geertrudis AM. Patterns of caregiver experiences among partners of cancer patients. Gerontologist 2000; 40: 738-47. • Nijboer C, Triemstra M, Tempelaar R, Sanderman R, van den Bos G. Determinants of caregiving experiences and mental health of partners of cancer patients. Cancer 1999; 86: 577-588. • Turnbull GB. The Ostomy files: Strategies for improving ostomy outcomes. Ostomy Wound Manage 2000; 48: 14-15.

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