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）：我们当前的医疗保健系统成本高昂、效率低下、支离破碎且不安全。要成功实现我们当前护理服务系统的现代化，需要有效且高效地实施创新的卫生 IT 工具，通过加强护理协调和人口层面的监督，支持传统一对一诊所就诊之外的临床工作。在我们基于实践的初级保健研究网络中，我们开发了一种健康服务模式，该模式使用健康 IT 基础设施来支持对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项名为“资源有限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 干预措施使用简单的 IT 界面来促进对逾期进行乳腺癌、宫颈癌和/或结直肠癌筛查的患者的识别、个性化联系和后续跟踪。其关键创新在于，每位患者的外展策略（即发送信件、给患者打电话、转介医疗保健导航器、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而选择。作为 R18-HS018161 的一部分，我们正在测试 TOP-CARE 的影响是否超过当前基于 IT 的人口管理的最先进水平。因此，对照组实践将接受增强标准护理（ASC），其定义为具有自动患者接触功能的人口级提醒系统。在此 R03 应用程序中，我们将使用 TOP-CARE 随机试验期间收集的有关成本、偏好以及临床和流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 的参与使用自动提醒之外的改进的影响，但 R03 经济分析将考虑 TOP-CARE 和 ASC 与当前临床实践相比的边际成本效益（基线标准护理，BSC）在机构。通过检查日益强化的干预措施的边际成本效益，我们将帮助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，因为它通常是大规模提供的初级保健网络。 CEA 旨在评估通过增强标准护理和 TOP-CARE 干预措施提高筛查率是否值得在 IT 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 计划与 BSC 相比每名筛查患者的边际成本”。这些机构将面临这项新技术是否值得投入人力和资本资源的决定。子目标旨在评估替代支付机制（例如按绩效付费举措）对干预措施成本效益的影响。 公共卫生相关性：鉴于我们的医疗保健系统成本高昂、效率低下且分散，有必要确定最有效的方法，在以人口为基础的初级保健背景下提供循证预防保健。我们提出了一项成本效益分析，以确定对易于使用、最先进的 IT 系统的投资与初级保健提供者对其患者的独特知识相结合，在多大程度上能改善乳腺、宫颈癌和结直肠癌筛查率。