Heather T Gold1, Nina Siman2, Allison M Cuthel3, Ann M Nguyen4, Hang Pham-Singer5, Carolyn A Berry2, Donna R Shelley6. 1. Department of Population Health, NYU Langone Health, New York, NY, USA. Heather.Gold@nyulangone.org. 2. Department of Population Health, NYU Langone Health, New York, NY, USA. 3. Ronald O. Perelman Department of Emergency Medicine, NYU Langone Health, New York, NY, USA. 4. Rutgers Center for State Health Policy, Rutgers University, New Brunswick, NJ, USA. 5. New York City Department of Health and Mental Hygiene, New York, NY, USA. 6. Department of Policy and Public Health Management, School of Global Public Health, New York University, New York, NY, USA.
Abstract
BACKGROUND: A stepped-wedge, cluster randomized controlled trial assessed the effectiveness of practice facilitation (PF) for adoption of guidelines for prevention and treatment of cardiovascular disease risk factors. This study estimated the associated cost of PF for guideline adoption in small, private primary care practices. METHODS: The cost analysis included categories for start-up costs, intervention costs, and practice staff costs for the implemented PF-guided intervention. We estimated the total 1-year costs to operate the program and calculated the mean and range of the cost-per-practice by quarter of the intervention. We estimated the lower and upper bounds for all salary expenses, rounding to the nearest $100. RESULTS:Total 1-year intervention costs for all 261 practices ranged from $7,900,000 to $10,200,000, with program and practice salaries comprising $6,600,000-$8,400,000 of the total. Start-up costs were a small proportion (3%) of the total 1-year costs. Excluding start-up costs, quarter 1 cost-per-practice was the most expensive at $20,400-$26,700, and quarter 4 was the least expensive at about $10,000. Practice staff time (compared with program staff time) was the majority of the staffing costs at 75-84%. CONCLUSIONS: The PF strategy costs approximately $10,000 per practice per quarter for program and practice costs, once implemented and running at highest efficiency. Whether this program is "worth it" to the decision-maker depends on the relative costs and effectiveness of their other options for improving cardiovascular risk reduction. TRIAL REGISTRATION: This study is retrospectively registered on January 5, 2016, at www.clinicaltrials.gov as NCT02646488 .
RCT Entities:
BACKGROUND: A stepped-wedge, cluster randomized controlled trial assessed the effectiveness of practice facilitation (PF) for adoption of guidelines for prevention and treatment of cardiovascular disease risk factors. This study estimated the associated cost of PF for guideline adoption in small, private primary care practices. METHODS: The cost analysis included categories for start-up costs, intervention costs, and practice staff costs for the implemented PF-guided intervention. We estimated the total 1-year costs to operate the program and calculated the mean and range of the cost-per-practice by quarter of the intervention. We estimated the lower and upper bounds for all salary expenses, rounding to the nearest $100. RESULTS: Total 1-year intervention costs for all 261 practices ranged from $7,900,000 to $10,200,000, with program and practice salaries comprising $6,600,000-$8,400,000 of the total. Start-up costs were a small proportion (3%) of the total 1-year costs. Excluding start-up costs, quarter 1 cost-per-practice was the most expensive at $20,400-$26,700, and quarter 4 was the least expensive at about $10,000. Practice staff time (compared with program staff time) was the majority of the staffing costs at 75-84%. CONCLUSIONS: The PF strategy costs approximately $10,000 per practice per quarter for program and practice costs, once implemented and running at highest efficiency. Whether this program is "worth it" to the decision-maker depends on the relative costs and effectiveness of their other options for improving cardiovascular risk reduction. TRIAL REGISTRATION: This study is retrospectively registered on January 5, 2016, at www.clinicaltrials.gov as NCT02646488 .
Authors: Steven D Culler; Michael L Parchman; Raquel Lozano-Romero; Polly H Noel; Holly J Lanham; Luci K Leykum; John E Zeber Journal: Ann Fam Med Date: 2013 May-Jun Impact factor: 5.166
Authors: Donna R Shelley; Thomas Gepts; Nina Siman; Ann M Nguyen; Charles Cleland; Allison M Cuthel; Erin S Rogers; Olugbenga Ogedegbe; Hang Pham-Singer; Winfred Wu; Carolyn A Berry Journal: Am J Prev Med Date: 2020-02-14 Impact factor: 5.043