A patient-centered digital cost simulator based on Time-Driven Based-Activity Costing: a proof-of-concept study of knee replacement in two private Portuguese hospitals

Background: Decision-makers need accurate information on intervention outcomes and costs to manage the healthcare system more efficiently. Literature proposes Time-Driven Based-Activity Costing (TDABC) as a cost measurement model that accounts for care cycle complexity. However, few studies show how to apply the TDABC model in a real context, considering the existing hospitals' information systems (IS). Our primary goal was to design a patient-centered digital cost simulator for assessing the provider's cost of care delivery in knee replacement surgeries. Additionally, to synthesize the learning experience of implementing it. Methods The digital cost simulator was designed on a set of spreadsheets, in Portugal based on the TDABC model and implemented in two Portuguese private hospitals located in two cities by two multidisciplinary TDABC operational teams. The cost simulator development and implementation followed the TDABC implementation steps proposed in the literature. Finally, we developed comprehensive dashboards to analyze the costing information by conducting two focus group sessions. Through one unstructured focus group, teams evaluated the implementation and development of the digital cost simulator. Results The cost simulator and the data structure for collecting the most relevant cost data were developed and tested. From the analysis of the developed dashboards, one can visualize the duration of the activities, the ones that can take the most time, the costliest activities, and resources, and how costs are distributed before, during, and after the surgery. Costs with Human Resources represent most costs during pre- and post-hospital surgery. However, during surgery, consumables are the costliest resources. Conclusion The developed simulator enlightened the healthcare provider's need for future improvements in the IS. From the simulator implementation, we concluded that the patient journey must drive data collection and analyses and breaking the activities into operations helps obtain time estimations and allocate resources better. Additionally, listing of the used resources should follow the financial IS classification. Moreover, Implementing the cost simulator requires the hospitals' IS to collect and interoperate with different data sources along the patient pathway. Finally, everyone agreed that its implementation involves the commitment of the healthcare provider's clinical and non-clinical teams.