Economic Analysis of an IT-Assisted Population-Based Cancer Screening Program

IT 辅助人群癌症筛查计划的经济分析

• 批准号: 8093542
• 负责人: Douglas Levy
• 金额: $ 9.99万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-03-01 至 2013-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8093542
• 关键词: Economic; Analysis; Assisted; Population; Based

DESCRIPTION (provided by applicant): Our current health care system is costly, inefficient, fragmented, and unsafe. Successfully modernizing our current care delivery system will require the effective and efficient implementation of innovative health IT tools to support clinical work outside of traditional one-on-one clinic visits by enabling greater care coordination and population-level oversight. Within our primary care Practice-based Research Network, we have developed a health delivery model that uses a health IT infrastructure to support non-visit based care for patient populations. In research funded by AHRQ [R18-HS018161], we are currently applying this approach to comprehensive cancer screening through an innovative program called Technology for Optimizing Population Care in A Resource-limited Environment (TOP-CARE). The TOP-CARE intervention uses a simple IT interface to facilitate the identification, individualized contact, and subsequent tracking of patients overdue for breast, cervical and/or colorectal cancer screening. Its key innovation is that the outreach strategy for each patient (i.e. send letter, phone patient, refer to health care navigator, decline screening) is chosen by that patient's primary care provider (PCP) based on his/her unique knowledge of the patient. As part of R18- HS018161, we are testing whether the impact of TOP-CARE exceeds the current state-of-the-art of IT-based population management. Thus, control group practices will receive augmented standard care (ASC) defined as a population-level reminder system with automated patient contacts. In this R03 application, we will use data collected during the TOP-CARE randomized trial about costs, preferences, and clinical and process outcomes to perform a formal cost-effectiveness analysis (CEA). While the randomized trial is focused on the impact of improvements above and beyond the use of automated reminders through the involvement of a patient's PCP, the R03 economic analysis will consider the marginal cost-effectiveness of both TOP-CARE and ASC compared to current clinical practice (baseline standard care, BSC) at the institution. By examining the marginal cost-effectiveness of increasingly intensive interventions, we will help understand the impact of technologically-improved care management not only in the context of high- performance medical care, but also against the backdrop of care as it is typically delivered in large primary care networks. The CEA is designed to evaluate whether improvements in screening rates from the augmented standard care and TOP-CARE interventions are worth the additional investment in IT and physician time. Specific Aim 1 is "To evaluate the marginal cost per patient screened of the TOP-CARE and ASC programs compared to BSC from an integrated care organization's perspective." It is these institutions that will be confronted with the decision of whether or not this new technology is a worthwhile investment of human and capital resources. A sub-aim is designed to evaluate the impact of alternative payment mechanisms (e.g., pay-for-performance initiatives) on the interventions' cost-effectiveness. PUBLIC HEALTH RELEVANCE: Given the costly, inefficient, and fragmented, state of our medical care system, it is essential to identify the most efficient means possible for delivering evidence-based preventive care in the context of population-based primary care. We propose a cost-effectiveness analysis to determine the extent to which investments in simple-to-use, state-of-the-art IT systems combined with primary care providers' unique knowledge of their patients, yield improvements in breast, cervical, and colorectal cancer screening rates.

描述（由申请人提供）：我们目前的医疗保健系统是昂贵的，低效的，分散的，不安全的。要成功实现我们当前的医疗服务系统现代化，就需要有效和高效地实施创新的医疗IT工具，通过加强医疗协调和人口层面的监督，支持传统一对一诊所访问之外的临床工作。在我们的初级保健实践为基础的研究网络，我们已经开发了一个健康提供模式，使用健康IT基础设施，以支持非访问为基础的护理病人群体。在由AHRQ资助的研究中[R18-HS 018161]，我们目前正在通过一项名为在资源有限的环境中优化人口护理技术（TOP-CARE）的创新计划将这种方法应用于全面的癌症筛查。TOP-CARE干预使用简单的IT界面，以便于识别、个性化联系和后续跟踪逾期进行乳腺癌、宫颈癌和/或结直肠癌筛查的患者。其主要创新在于，每位患者的外展策略（即发送信函、给患者打电话、转诊至医疗保健导航员、拒绝筛查）由患者的初级保健提供者根据其对患者的独特了解进行选择。作为R18-HS 018161的一部分，我们正在测试TOP-CARE的影响是否超过当前基于IT的人口管理的最新水平。因此，对照组的做法将接受增强标准护理（ASC）定义为人口水平的提醒系统与自动化的病人联系。在此R 03应用程序中，我们将使用在TOP-CARE随机试验期间收集的有关成本、偏好以及临床和过程结果的数据来执行正式的成本效益分析（CEA）。虽然随机试验的重点是通过患者PCP的参与，在使用自动提醒之外的改进的影响，但R 03经济分析将考虑TOP-CARE和ASC与该机构当前临床实践（基线标准治疗，BSC）相比的边际成本效益。通过研究日益强化的干预措施的边际成本效益，我们将有助于了解技术改进的护理管理的影响，不仅在高性能医疗保健的背景下，而且在护理的背景下，因为它通常是在大型初级保健网络提供。CEA旨在评估增强标准护理和TOP-CARE干预措施对筛查率的改善是否值得在IT和医生时间方面进行额外投资。具体目标1是“从综合护理组织的角度，评估TOP-CARE和ASC计划与BSC相比筛选的每位患者的边际成本。“正是这些机构将面临这样一个决定，即这项新技术是否是一项值得的人力和资本投资。次级目标旨在评估替代支付机制的影响（例如，按业绩计薪倡议）对干预措施的成本效益的影响。 公共卫生相关性：鉴于我们的医疗保健系统成本高、效率低、支离破碎，因此必须确定在以人口为基础的初级保健背景下提供循证预防保健的最有效手段。我们提出了一个成本效益分析，以确定在何种程度上投资于简单易用，国家的最先进的IT系统结合初级保健提供者的独特的知识，他们的病人，产量提高乳腺癌，宫颈癌和结直肠癌的筛查率。