Assessing innovative care models for musculoskeletal disorders' management in the emergency department using Time-Driven Activity-Based Costing

Objectives: Compare the average cost of an emergency department (ED) visit between three ED care models, namely management by an emergency physician (EP) alone (usual care), management by a primary contact physiotherapist (PT) and an EP (intervention), and management by a PT alone (sensitivity analysis). Methods: Cost study (Canadian Public Payer perspective) based on data collected during a pragmatic randomized clinical trial (2018-2019) conducted in an urban Canadian academic ED (CHUL, Quebec City, Canada; n=78, 18-80 years old). Costs incurred for the management of persons presenting to the ED for a minor musculoskeletal disorder (MSKD) were calculated using Time-Driven Activity-Based Costing, in which time invested with a patient determines care costs. The main outcome measure was the average cost of an ED visit. Generalized linear models with Gamma distributions and log links were used to assess whether there were significant differences in average costs between the care models. Results: Mean ED visit cost was $278.47 (2019 $CAD, 95%CI: $223.70, $357.42) for PT and EP management, compared with $254.68 for EP management ($178.48, $346.68), resulting in a non-significant absolute difference of 23.79 CAD/patient ($-87.04, $135.74) between models (p=.58). Sensitivity analyses showed that the average cost of ED management by a PT was $194.40 ($160.86, $235.14), representing a non-significant average saving of 60.28 CAD/patient ($-168.19, $31.46) compared to EP management. Conclusion: This study is a first step towards a better understanding of the costs incurred by the Canadian Public Payer for the management of persons presenting with MSKDs in the ED. Primary contact physiotherapists have the potential to complement care of MSKD ED patients without increasing healthcare costs.