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

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信息技术工具，通过加强护理协调和人口层面的监督，支持传统的一对一门诊就诊之外的临床工作。在我们的初级保健基于实践的研究网络中，我们开发了一种卫生服务模式，该模式使用卫生IT基础设施来支持患者群体的非就诊护理。在AHRQ [R18-HS018161]资助的研究中，我们目前正在通过一个名为“资源有限环境下优化人群护理技术”（TOP-CARE）的创新项目，将这种方法应用于全面的癌症筛查。TOP-CARE干预使用一个简单的IT界面来方便识别、个性化联系和后续跟踪乳腺癌、宫颈癌和/或结直肠癌筛查逾期患者。它的关键创新在于，每位患者的外展策略（即寄信、给患者打电话、向卫生保健导航员咨询、拒绝筛查）由患者的初级保健提供者（PCP）根据他/她对患者的独特了解来选择。作为R18- HS018161的一部分，我们正在测试TOP-CARE的影响是否超过目前最先进的基于it的人口管理。因此，对照组实践将接受增强标准护理（ASC），定义为具有自动患者接触的人口水平提醒系统。在这个R03申请中，我们将使用TOP-CARE随机试验期间收集的关于成本、偏好、临床和过程结果的数据来执行正式的成本-效果分析（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R03经济分析将考虑与该机构当前临床实践（基线标准护理，BSC）相比，TOP-CARE和ASC的边际成本效益。通过检查越来越密集的干预措施的边际成本效益，我们将帮助理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，而且在大型初级保健网络中通常提供的护理背景下。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信息技术和医生时间上进行额外投资。具体目标1是“从综合护理组织的角度，评估TOP-CARE和ASC项目与BSC相比筛查的每位患者的边际成本。”正是这些机构将面临这样的决定：这项新技术是否值得投入人力和资本资源。一项次级目标旨在评价替代性支付机制（例如按业绩付费倡议）对干预措施成本效益的影响。

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.