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

1. A Cost-Effectiveness Analysis of a Multimedia Learning Education Programs for Stoma Patients Shu-Fen LoRN,MSN, Instructor, Department of Nursing ,Tzu Chi College of Technology & Doctoral Student, Graduate Institute of Nursing National Taiwan University Good morning, ladies and gentlemenSuppose your medical service budget was cut by 50% tomorrow, How would you go about Keep quality service of your patients? My object today is A Cost-Effectiveness Analysis of a Multimedia Learning Education Programs for Stoma PatientsThis talk is divided into four main parts:firstly, I�ll be talking about the research backgroundSecondly, I�m going to be telling you about the research methodand then I�ll go on to reporting the research resultFinally, I�ll go on to highlight in more depth the implications of the data in the files in front of you. Good morning, ladies and gentlemenSuppose your medical service budget was cut by 50% tomorrow, How would you go about Keep quality service of your patients? My object today is A Cost-Effectiveness Analysis of a Multimedia Learning Education Programs for Stoma PatientsThis talk is divided into four main parts:firstly, I�ll be talking about the research backgroundSecondly, I�m going to be telling you about the research methodand then I�ll go on to reporting the research resultFinally, I�ll go on to highlight in more depth the implications of the data in the files in front of you.

2. May 4,2007 2 Why do we need the relevance of economic evaluation? The prevalence of colon cancer among all of the cancers is top three in Taiwan. The adverse impacts on stoma patients are physical, psychological, and social As we as know, nurses staffs provided quality of care, then can improve the patients quality of life when their suffer illness The prevalence of colon cancer among all of the cancers is top three in Taiwan. The adverse impacts on stoma patients are physical, psychological, and social As we as know, nurses staffs provided quality of care, then can improve the patients quality of life when their suffer illness

3. May 4,2007 3 Why do we need the relevance of economic evaluation? The staff plays a important role for the stoma patients who suffer from a post-surgical change of body functions and social roles. High quality stoma patient care is not easily achieved in Taiwan because there are only eight internationally certified enterostomal nusres present here Secondly, there are no comprehensive training programs in Taiwan as yet Then, the majority of staff are assigned eight to ten patients per day, making it difficult to allocate enough time to educate patient about health promotion and disease prevention. The staff plays a important role for the stoma patients who suffer from a post-surgical change of body functions and social roles. High quality stoma patient care is not easily achieved in Taiwan because there are only eight internationally certified enterostomal nusres present here Secondly, there are no comprehensive training programs in Taiwan as yet Then, the majority of staff are assigned eight to ten patients per day, making it difficult to allocate enough time to educate patient about health promotion and disease prevention.

4. May 4,2007 4 Why do we need the relevance of economic evaluation? Many studies indicate that a multimedia education is beneficial in advancing knowledge and improving learning satisfaction Multimedia health education programs not only provide patients useful information when there are no health professionals around but also allow an improvement over the insufficient information currently provided in traditional clinical practice Many studies indicate that a multimedia education is beneficial in advancing knowledge and improving learning satisfaction Multimedia health education programs not only provide patients useful information when there are no health professionals around but also allow an improvement over the insufficient information currently provided in traditional clinical practice

5. May 4,2007 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 The purpose of this study was to evaluate whether intervention was more or less cost-effective than traditional care for colon cancer patients. In particular, the researchers hoped to establish the cost-effectiveness (CE) ratios in two groups we hypothesized that the patient in intervention group would experience less care costs, more knowledge, positive attitude, and better self-care behavior than the control group .The purpose of this study was to evaluate whether intervention was more or less cost-effective than traditional care for colon cancer patients. In particular, the researchers hoped to establish the cost-effectiveness (CE) ratios in two groups we hypothesized that the patient in intervention group would experience less care costs, more knowledge, positive attitude, and better self-care behavior than the control group .

6. May 4,2007 6 Table1. The Conceptual CEA in MLEP and CESP with Stoma patients In this study we based on the cost effectiveness analysis model of Boardman and Gramlich, In this model, we divide into three parts �participant� meant the patients undergoing stoma surgery. �Non-participant� meant the persons who are not participants. �Society� meant all of the people including �participant� and �non-participant�. The costs for each patient can be divided into three parts: health care cost, film making cost ,and family burdensThe effectiveness measures the knowledge of self-care, attitude of self-care , and behavior of self-care . In this study we based on the cost effectiveness analysis model of Boardman and Gramlich, In this model, we divide into three parts �participant� meant the patients undergoing stoma surgery. �Non-participant� meant the persons who are not participants. �Society� meant all of the people including �participant� and �non-participant�. The costs for each patient can be divided into three parts: health care cost, film making cost ,and family burdensThe effectiveness measures the knowledge of self-care, attitude of self-care , and behavior of self-care .

7. May 4,2007 7 Materials and Methods selection criteria included Stoma patient admitted to the surgical unit 18 years or older speak and read Chinese. The sample selection criteria included: (1) any stoma patient admitted to the surgical unit; (2) at least 18 years of age; and (3) able to speak and read Chinese. In the mean time, the study was also obtained from Tzu Chi Medical Center�s IRB. The data-collection was performed by a single researcher. The sample selection criteria included: (1) any stoma patient admitted to the surgical unit; (2) at least 18 years of age; and (3) able to speak and read Chinese. In the mean time, the study was also obtained from Tzu Chi Medical Center�s IRB. The data-collection was performed by a single researcher.

8. May 4,2007 8 Materials and Methods The development of the intervention was based on a literature review of prior research results.First, the intervention including type of stoma, anatomy, indications, stoma care, irrigation with post-surgery, which used film and pictures in the program.On average, each program session took 30-45 minutes. The development of the intervention was based on a literature review of prior research results.First, the intervention including type of stoma, anatomy, indications, stoma care, irrigation with post-surgery, which used film and pictures in the program.On average, each program session took 30-45 minutes.

9. May 4,2007 9 First at all, when the participants meet the selection criteria were randomly assigned to the experimental or control group In the experimental group received individual MLEP by one instructor,and the control group subjects received CESP. Each group was followed up for one week.First at all, when the participants meet the selection criteria were randomly assigned to the experimental or control group In the experimental group received individual MLEP by one instructor,and the control group subjects received CESP. Each group was followed up for one week.

10. May 4,2007 10 Reliability & Validity In this study, effectiveness was non-monetary, including three instruments. All instruments have good .reliability and validity test.In this study, effectiveness was non-monetary, including three instruments. All instruments have good .reliability and validity test.

11. May 4,2007 11 Statistical analysis SPSS 14.0 to do statistical analysis. All data were analyzed using SPSS version 14.0,Descriptive statistics included percentage, mean, and standard deviation. Inferential statistics included Chi-square, and independent sample t-test. Cost were converted to US dollarsAll data were analyzed using SPSS version 14.0,Descriptive statistics included percentage, mean, and standard deviation. Inferential statistics included Chi-square, and independent sample t-test. Cost were converted to US dollars

12. May 4,2007 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. Totally, have fifty four patients enrolledAges ranged from eighteen to ninety yearsMean was sixty point forty-four yearssixty-three percent received elementary school or below educationfifty-seven percent were malemajority were married ,living with families and not employed No significant difference in demographic variables between two groupsTotally, have fifty four patients enrolledAges ranged from eighteen to ninety yearsMean was sixty point forty-four yearssixty-three percent received elementary school or below educationfifty-seven percent were malemajority were married ,living with families and not employed No significant difference in demographic variables between two groups

13. May 4,2007 13 This table displays the costs of stoma education services for each person in these two groups. This table displays the costs of stoma education services for each person in these two groups.

14. May 4,2007 14 From these data, the cost per person in MLEP was estimated at US dollar seven thousand nine hundred forty-one point seventy-one, while the cost per person in CESP was estimated at US dollar eight thousand five hundred seventy point fifty-four. From these data, the cost per person in MLEP was estimated at US dollar seven thousand nine hundred forty-one point seventy-one, while the cost per person in CESP was estimated at US dollar eight thousand five hundred seventy point fifty-four.

15. May 4,2007 15 In this table show that the each of the effectiveness indicators showed significant differences between the two groups. That means subjects in the MLEP revealed significantly better outcomes in KSC, ASC, and BSC than those in CESP. In this table show that the each of the effectiveness indicators showed significant differences between the two groups. That means subjects in the MLEP revealed significantly better outcomes in KSC, ASC, and BSC than those in CESP.

16. May 4,2007 16 Then, according to single effectiveness score analysis for each patient, the researchers transferred all of the scores into a full range of one hundred and summed to make a single effectiveness score in this Table.Therefore, the average scores of effectiveness were participants receiving MLEP showed better clinical outcomes than CESP group.The C/E Ratio of the MLEP group was both more effective and less costly , compared the CESP group. This results in a cost savings if MLEP is used in lieu of CESP. Then, according to single effectiveness score analysis for each patient, the researchers transferred all of the scores into a full range of one hundred and summed to make a single effectiveness score in this Table.Therefore, the average scores of effectiveness were participants receiving MLEP showed better clinical outcomes than CESP group.The C/E Ratio of the MLEP group was both more effective and less costly , compared the CESP group. This results in a cost savings if MLEP is used in lieu of CESP.

17. May 4,2007 17 The sensitivity analysis The researchers assumed that stoma care skill and protocol would not always revise within five years .The cost effectiveness ratio of MLEP can be reduced to forty-four point twenty-one at the end of five years from original forty four point thirty two after one intervention cycle,while that of CESP remains the same at seventy-seven point twenty-threeThe sensitivity analysis The researchers assumed that stoma care skill and protocol would not always revise within five years .The cost effectiveness ratio of MLEP can be reduced to forty-four point twenty-one at the end of five years from original forty four point thirty two after one intervention cycle,while that of CESP remains the same at seventy-seven point twenty-three

18. May 4,2007 18 Discussion In this study,First, we find greater cost-effectiveness. Second, the patients in the MLEP group showed significantly greater improvement in KSC, ASC, and BSC than those in CESP third, the family burden in MLEP was less costly than that in CESP. This can be achieved through the recycling and reuse of existing health promotion and teaching materials and media. Thus, the effectiveness of MLEP over the CESP has been demonstrated by this study In this study,First, we find greater cost-effectiveness. Second, the patients in the MLEP group showed significantly greater improvement in KSC, ASC, and BSC than those in CESP third, the family burden in MLEP was less costly than that in CESP. This can be achieved through the recycling and reuse of existing health promotion and teaching materials and media. Thus, the effectiveness of MLEP over the CESP has been demonstrated by this study

19. May 4,2007 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. May 4,2007 20

21. May 4,2007 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, �ner A, Irk�r�c� O, Sultan A, Se�il �. 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. May 4,2007 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.