Costs associated with implementation of computer-assisted clinical decision support system for antenatal and delivery care: case study of Kassena-Nankana district of northern Ghana

Maxwell Ayindenaba Dalaba; Patricia Akweongo; John Williams; Happiness Pius Saronga; Pencho Tonchev; Rainer Sauerborn; Nathan Mensah; Antje Blank; Jens Kaltschmidt; Svetla Loukanova

doi:10.1371/journal.pone.0106416

Costs associated with implementation of computer-assisted clinical decision support system for antenatal and delivery care: case study of Kassena-Nankana district of northern Ghana

PLoS One. 2014 Sep 2;9(9):e106416. doi: 10.1371/journal.pone.0106416. eCollection 2014.

Authors

Affiliations

¹ University of Heidelberg, Institute of Public Health, Heidelberg, Germany; Navrongo Health Research Centre, Navrongo, Ghana.
² University of Ghana, School of Public Health, Accra, Ghana.
³ Navrongo Health Research Centre, Navrongo, Ghana.
⁴ University of Heidelberg, Institute of Public Health, Heidelberg, Germany; Muhimbili University of Health and Allied Sciences, Behavioural Sciences Department, School of Public Health and Social Sciences, Dar es Salaam, Tanzania.
⁵ Medical University, Surgical Clinic, Pleven, Bulgaria.
⁶ University of Heidelberg, Institute of Public Health, Heidelberg, Germany.
⁷ Navrongo Health Research Centre, Navrongo, Ghana; Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Heidelberg, Germany.
⁸ Department of Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl Klinik), University Hospital of Heidelberg, Heidelberg, Germany.

Abstract

Objective: This study analyzed cost of implementing computer-assisted Clinical Decision Support System (CDSS) in selected health care centres in Ghana.

Methods: A 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.

Results: Twenty-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%.

Conclusions: The 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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Decision Making, Computer-Assisted*
Decision Support Systems, Clinical / economics*
Delivery, Obstetric / economics*
Female
Ghana
Health Care Costs*
Health Plan Implementation
Humans
Labor, Obstetric
Maternal Health Services / economics*
Pregnancy
Prenatal Care / economics*
Referral and Consultation

Grants and funding

The study is part of the main QUALMAT research project funded as part of the 7th Framework Programme of the European Union (grant agreement 22982). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.