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.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Small Research Grants (R03)
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Health Care Technology and Decision Science (HTDS)
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Roper, Rebecca
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Massachusetts General Hospital
United States
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Levy, Douglas E; Munshi, Vidit N; Ashburner, Jeffrey M et al. (2015) Health IT-assisted population-based preventive cancer screening: a cost analysis. Am J Manag Care 21:885-91