Background
Methods
Study design and data collection
Case-review
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Cmin: Total minimum estimated cost (Euros), considering all the performed Teleconsultation, TC.
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Cmax: Total maximum estimated cost (Euros), considering all the performed Teleconsultation, TC.
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Hi: Refers to each partner Hospital (site B; e.g. Aveiro, Castelo Branco, Covilhã).
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TA: Travel cost A, estimated for each Hi, considering 2 performed TC per patient. It is the minimum possible cost for travelling from Hi to CHUC, per patient, for 2 TC, considering the three alternatives: (a) An average estimation calculated using ViaMichelin route planner, including petrol and toll fees; (b) An estimation using the cost of 0.36 Euro/Kilometer (established by a national law applied in Public organizations); (c) In case of emergency, using an ambulance on request, which considers the cost of 3 Euro/50 Kilometer plus 0.15 Euros for each additional Kilometer, according to the national law.
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TotalTCHi: Total TC, performed by each Hi.
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CwithTC: Estimated administrative and logistic cost-saving through telemedicine (Euros); it is calculated using the estimated administrative and logistic total cost without telemedicine (CwithoutTC) and the estimated administrative and logistic real cost (CadmLog).
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CadminLog: Estimated administrative and logistic real cost (Euros) for the total performed TC by each hospital Hi; it consider the out-patient consultation standard price (StPriceHi) established by national law for each hospital, Hi.
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CwithoutTC: Estimated administrative and logistic total cost without telemedicine (Euros) for the Total performed TC by each hospital Hi; it consider both the out-patient consultation standard prices (StPriceHi and StPriceCHUC) for the partner Hospital (Hi; site B) and the CHUC (site A).
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Hi: Refers to each partner Hospital (site B; e.g. Aveiro, Castelo Branco, Covilhã).
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TotalTCHi: Total TC (Euros), performed by each Hi.
Interviews with key-members of the organization
The organizational culture assessment instrument survey (OCAI)
Critical factors’ identification and organizational culture assessment
The Kingdon’s process streams
Results
Case-review
The telemedicine service’s characterization
Most representative Telemedicine Sub-specialties (for NHS) | Teleconsultations (for NHS) | Pediatric Cardiology out-patient consultations | Teleconsultations by Pediatric Cardiology out-patient consultations | ||||||||
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Telecardiology (total of 13,903 patients) | Fetal Telecardiology (total of 319 patients) | Total | First Consultation | Subsequent Consultations | Total | First Consultation | Subsequent Consultations | Total | First Consultation | Subsequent Consultations | |
2007 | 1363 | 0 | 1363 | 1288 | 75 | 6734 | 2783 | 3951 | 20.2% | 46.3% | 1.9% |
2008 | 1842 | 36 | 1878 | 1872 | 6 | 7662 | 3680 | 3982 | 24.5% | 50.9% | 0.2% |
2009 | 2137 | 60 | 2197 | 2193 | 4 | 8841 | 4212 | 4629 | 24.9% | 52.1% | 0.1% |
2010 | 2613 | 89 | 2702 | 1938 | 764 | 9979 | 4020 | 5959 | 27.1% | 48.2% | 12.8% |
2011 | 2579 | 124 | 2703 | 1780 | 923 | 10,235 | 3892 | 6343 | 26.4% | 45.7% | 14.6% |
2012 | 3094 | 78 | 3172 | 1947 | 1225 | 11,174 | 4405 | 6769 | 28.4% | 44.2% | 18.1% |
2013 | 3462 | 0 | 3462 | 2006 | 1456 | 12,229 | 4693 | 7536 | 28.3% | 42.7% | 19.3% |
2014 | 3510 | 0 | 3510 | 2055 | 1455 | 12,142 | 4561 | 7581 | 28.9% | 45.1% | 19.2% |
2015 | 3394 | 214 | 3608 |
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2016 | 3131 | 218 | 3349 |
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Total | 27,125 | 819 | 27,944 | 15,079 | 5908 | 78,996 | 32,246 | 46,750 | 35.4% | 46.8% | 12.6% |
Cost-benefit analysis
Interviews with key-elements and observational analysis
Observational analysis - understanding the process
Average TC duration in site A, by Patient (minutes) | Estimated average duration of the TC in site B, by Patient (minutes) |
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5.82 | 8.82 |
Organizational culture assessment
Culture alternatives | Now average score/categories | Preferred average score/categories | Differences (Preferred - Now) |
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A - Clan | 42.9 | 39.8 | −3.1 |
B - Adhocracy | 24.1 | 27.5 | 3.4 |
C - Market | 17.2 | 17.2 | −0.1 |
D - Hierarchy | 15.8 | 15.5 | −0.2 |
Critical factors identification and organizational culture assessment
The culture trend
Categories | Now Average score/categories | Preferred Average score/categories | Culture Change by categories | ||||||
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A | B | C | D | A | B | C | D | ||
1. Dominant characteristics |
47.0
| 27.0 | 18.0 | 8.0 |
37.5
| 35.0 | 20.4 | 7.1 | |
2. Organizational leadership |
37.7
| 28.3 | 15.3 | 18.7 | 28.9 | 23.9 | 9.3 |
37.9
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3. Management of employees |
50.0
| 18.2 | 13.6 | 18.2 |
45.0
| 20.4 | 17.5 | 17.1 | |
4. Organization glue |
41.4
| 17.9 | 30.0 | 10.7 |
38.8
| 25.4 | 29.6 | 6.2 | |
5. Strategic emphasis |
36.4
| 35.0 | 13.6 | 15.0 | 33.5 |
41.5
| 14.2 | 10.8 | |
6. Criteria of success |
45.0
| 18.0 | 13.0 | 24.0 |
55.0
| 18.8 | 11.9 | 14.2 | |
Total score | 42.9 | 24.1 | 17.2 | 15.8 | 39.8 | 27.5 | 17.2 | 15.5 | |
100.0 | 100.0 |