Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis

Hogg, William; Baskerville, Bruce; Lemelin, Jacques

doi:10.1186/1472-6963-5-20

Cited by 49 publications

(49 citation statements)

References 36 publications

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“…This fi nding is consistent with a prior estimate by Hogg and colleagues for a facilitation intervention to improve preventive services. 12 Approximately 47% of the total practice facilitation costs were attributable to practice assessment and start-up activities, with another 25% attributable to facilitation visits. Although some may question the necessity of the assessment and start-up costs, many, if not all, of these small independent practices had no performance data.…”

Section: Discussionmentioning

confidence: 99%

“…Developing cost estimates associated with administering a practice facilitation program in local or regional primary care settings is necessary to be able to plan for the supporting infrastructure. 12 The purpose of this article is to report the variable costs (those costs that occurred while carrying out all practice facilitation activities) of providing prac- …”

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confidence: 99%

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Cost Estimates for Operating a Primary Care Practice Facilitation Program

Culler

Parchman

Lozano-Romero

et al. 2013

The Annals of Family Medicine

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PURPOSE Practice facilitation is widely recognized as a promising method for achieving large-scale practice redesign. Little is known, however, about the cost of providing practice facilitation to small primary practices from the prospective of an organization providing facilitation activities. METHODSWe report practice facilitation costs on 19 practices in South Texas that were randomized to receive facilitation activities. The study design assured that each practice received at least 6 practice facilitation visits during the intervention year. We examined only the variable cost associated with practice facilitation activities. Fixed or administrative costs of providing facilitation actives were not captured. All facilitator activities (time, mileage, and materials) were selfreported by the practice facilitators and recorded in spreadsheets. RESULTSThe median total variable cost of all practice facilitation activities from start-up through monitoring, including travel and food, was $9,670 per practice (ranging from $8,050 to $15,682). Median travel and food costs were an additional $2,054 but varied by clinic. Approximately 50% of the total cost is attributable to practice assessment and start-up activities, with another 31% attributable to practice facilitation visits. Sensitivity analysis suggests that a 24-visit practice facilitation protocol increased estimated median total variable costs of all practice facilitation activities only by $5,428, for a total of $15,098. CONCLUSIONSWe found that, depending on the facilitators wages and the intensity of the intervention, the cost of practice facilitation ranges between $9,670 and $15,098 per practice per year and have the potential to be cost-neutral from a societal prospective if practice facilitation results in 2 fewer hospitalizations per practice per year. 2013;11:207-211. doi:10.1370/afm.1496. Ann Fam Med INTRODUCTIONI mproving primary care practices in the United States is a widely agreed-upon strategy for improving access to and quality of health care without increasing costs.1-6 Practice facilitation is a promising and practical method for supporting practice redesign in small primary care settings.7-10 Often improvements targeted by practice facilitation programs result in improved quality of care and process outcomes. A recent systematic review found that practices receiving practice facilitation are 2.76 (95% CI, 2.18-3.43) times more likely to make changes necessary to implement evidence-based guidelines and concludes that it is a robust intervention for improving primary care. 11Although practice facilitation is widely recognized as a promising method for achieving large-scale practice redesign, little is known about its cost. Developing cost estimates associated with administering a practice facilitation program in local or regional primary care settings is necessary to be able to plan for the supporting infrastructure. 12 The purpose of this article is to report the variable costs (those costs that occurred while carrying out all practice ...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Cost Estimates for Operating a Primary Care Practice Facilitation Program

Culler

Parchman

Lozano-Romero

et al. 2013

The Annals of Family Medicine

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“…Hogg et al 49 analyzed the overall cost-effectiveness of their similar intervention, finding that, despite the high cost of facilitation, considering the increased rate of delivery of key preventive services the intervention was cost-effective. Six months was barely enough time to effect these changes in most of our practices.…”

Section: Discussionmentioning

confidence: 99%

Implementation of Evidence-Based Preventive Services Delivery Processes in Primary Care: An Oklahoma Physicians Resource/Research Network (OKPRN) Study

Mold¹,

Aspy²,

Nagykáldi³

2008

The Journal of the American Board of Family Medicine

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Background: Previous research has found that wellness visits, recall and reminder systems, and standing orders are associated with higher rates of delivery of preventive services in primary care practices. However, there is little information about how to help practices implement these processes.Methods: A 6-month randomized, controlled trial comparing a multicomponent quality improvement intervention to feedback and benchmarking. One clinician/nurse team from each of 24 practices was randomly assigned to one of 2 study arms. Intervention practices received performance feedback, peerto-peer education (academic detailing), a practice facilitator, and computer (information technology) support. Implementation of the 3 targeted processes was determined by a blinded 3-clinician panel that reviewed transcribed clinician interviews before and after intervention using performance definitions. Rates of delivery of selected preventive services were determined by chart audit.Results: Intervention practices implemented more of the processes than control practices overall (P ‫؍‬ .003), for adults (P ‫؍‬ .05), and for children (P ‫؍‬ .04). They were also more likely to implement at least one of the processes for children (P ‫؍‬ .04) and to implement standing orders for either children or adults (P ‫؍‬ .02). Mammography rates increased significantly. Neither clinician and practice characteristics nor clinician readiness to change predicted implementation.Conclusions: A multicomponent implementation strategy consisting of feedback, benchmarking, academic detailing, facilitation, and IT support increased implementation of evidence-based processes for delivering preventive services to a greater extent than performance feedback and benchmarking alone.

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“…However, Hogg et al 6 recently demonstrated that outreach facilitation is an expensive, but cost-effective way to improve the quality of preventive medicine in primary care. In this study, the cost of a facilitator was offset by the reduction in inappropriate testing and increase in appropriate services, producing a net cost savings.…”

Section: Cost-effectivenessmentioning

confidence: 99%

Practice Facilitators and Practice-based Research Networks

Nagykáldi¹,

Mold²,

Robinson³

et al. 2006

The Journal of the American Board of Family Medicine

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Practice facilitators (PFs) are health care professionals, who assist primary care practices in research and quality improvement activities. Their work goes beyond data collection and feedback and includes practice enhancement methods to facilitate system-level changes. PFs provide a framework for translating research into practice by building relationships, improving communication, facilitating change, and sharing resources in practice-based research networks (PBRNs). Scope/Range of ActivitiesWithin PBRNs, PFs participate most often in externally funded research projects initiated by an academic organization. Although network clinicians may have an active role in the planning and the completion of these projects, the activity of PFs is driven mostly by the study protocols. In these projects, PFs act as research assistants. However, the PF model underscores the importance of relationship building. Relationships developed between the PFs and a group of practices is essential to implement and sustain interventions in primary care. PFs also assist clinicians in local research and QI projects initiated by the practices. Clinicians may develop project ideas on their own, or PFs can help the practices initiate projects based on an assessment of the practice's needs and potential to implement interventions. Project ideas and solutions are often shared with other providers within a PBRN via the PFs (cross-pollination). 4,5 Relationships with PracticesBecause translational research projects often require the re-engineering of the practice, it is espe-

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Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis

Cited by 49 publications

References 36 publications

Cost Estimates for Operating a Primary Care Practice Facilitation Program

Cost Estimates for Operating a Primary Care Practice Facilitation Program

Implementation of Evidence-Based Preventive Services Delivery Processes in Primary Care: An Oklahoma Physicians Resource/Research Network (OKPRN) Study

Practice Facilitators and Practice-based Research Networks

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