As part of its partnership with the Patient-Centered Outcomes Research Institute (PCORI), Medical Care has published its first PCORI-sponsored article collection, which provides specific information about the costs that healthcare systems can expect to incur in promoting the uptake of specific evidence-based programs. In September’s special issue, five project teams that received Implementation Award funding from PCORI describe their approaches. This includes the details of the patient-centered programs themselves and the methods for determining the costs of implementing those programs into routine clinical practice. In each case, there is a special focus through which the investigators report on their cost findings.
Valerie Lehman, MHA, program officer for dissemination and implementation at PCORI, and colleagues provided highlights in an introductory editorial.
“Having cost information available during the decision-making process—before implementation occurs—is particularly important so that leaders can consider financial implications and weigh trade-offs before investing in implementing an evidence-based practice change. Yet information about the cost of implementation is not often available.”
Accounting for context-specific considerations when assessing cost is crucial
The Principles of Patient-Centered Care
One paper in the collection reports on a team that assessed the costs of implementing Connect to Health. Connect to Health is an evidence-based pediatric weight management program, launched at three healthcare systems that care for pediatric populations with a disproportionately high prevalence of obesity. These include: Denver Health; Prisma Health in Greenville, South Carolina; and Massachusetts General Hospital in Boston.
Natalie Smith, PhD and Douglas E. Levy, PhD, from the Mongan Institute Health Policy Research Center, together with colleagues, used time-driven, activity-based costing methods. Specifically, each of the three sites developed a process map and a detailed report of all implementation actions. Then, they aligned those actions with major implementation requirements (e.g., electronic health record integration) or strategies (e.g., providing clinician training). For each action, sites identified the personnel involved and estimated the time they spent, and the research team then estimated the total costs of implementation and broke down the costs for major categories of activities.
Process maps showed the program integrated easily into well-child visits. Overall implementation costs ranged from $77,103 to $142,721, with setting up the technological aspects of the program being a major driver of costs. Other drivers included training, engaging stakeholders, and audit and feedback activities. However, there was variability across healthcare systems based on how they chose to implement the program and expend resources.
Site-specific data can be useful to other healthcare centers
“Beyond just the technological aspects of the program, our findings provide valuable information for future adoption and implementation decisions. They clearly delineate what kinds of costs sites should expect.” This includes, ” the personnel involved in various implementation actions and how costs were distributed across pre-implementation and implementation.” Dr. Smith and her co-authors say. “Disaggregating costs across different categories allows future sites to better plan for what to expect in implementation. Even if the exact dollar amounts will likely be different than what was observed in the three research sites.”
Ms. Lehman and the other editorialists add that all five papers “provide more information to healthcare decision-makers on the actual observed costs associated with implementing evidence-based practices. Each team was able to capture the specific types of personnel, as well as the detailed tasks and activities, involved in implementation.”
Essentially laying out clear pathways for future sites considering whether and how to put these evidence-based practices into place.
This collection received funding from the Patient-Centered Outcomes Research Institute (PCORI), Washington, DC. The collection draws from the experience of PCORI-funded teams who have worked to implement evidence-based practice within healthcare delivery settings.
About Medical Care
Rated as one of the top ten journals in healthcare administration, Medical Care is devoted to all aspects of the administration and delivery of healthcare. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments. Medical Care publishes evidence related to the research, planning, organization, financing, provision, and evaluation of health services.
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Ben King