Rethinking How We Measure Costs in Implementation Research.
Identifieur interne : 000094 ( Main/Exploration ); précédent : 000093; suivant : 000095Rethinking How We Measure Costs in Implementation Research.
Auteurs : Todd H. Wagner [États-Unis]Source :
- Journal of general internal medicine [ 1525-1497 ] ; 2020.
Abstract
BACKGROUND
Hospitals and other health care delivery organizations are sometimes resistant to implementing evidence-based programs, citing unknown budgetary implications.
OBJECTIVE
In this paper, I discuss challenges when estimating health care costs in implementation research.
DESIGN
A case study with intensive care units highlights how including fixed costs can cloud a short-term analysis.
PARTICIPANTS
None.
INTERVENTIONS
None.
MAIN MEASURES
Health care costs, charges and payments.
KEY RESULTS
Cost data should accurately reflect the opportunity costs for the organization(s) providing care. Opportunity costs are defined as the benefits foregone because the resources were not used in the next best alternative. Because there is no database of opportunity costs, cost studies rely on accounting data, charges, or payments as proxies. Unfortunately, these proxies may not reflect the organization's opportunity costs, especially if the goal is to understand the budgetary impact in the next few years.
CONCLUSIONS
Implementation researchers should exclude costs that are fixed in the time period of observation because these assets (e.g., space) cannot be used in the next best alternative. In addition, it is common to use costs from accounting databases where we implicitly assume health care providers are uniformly efficient. If providers are not operating efficiently, especially if there is variation in their efficiency, then this can create further problems. Implementation scientists should be judicious in their use of cost estimates from accounting data, otherwise research results can misguide decision makers.
DOI: 10.1007/s11606-020-06104-6
PubMed: 33107005
Affiliations:
Links toward previous steps (curation, corpus...)
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Wagner</name><affiliation wicri:level="1"><nlm:affiliation>VA Health Economics Resource Center, 795 Willow Rd., 152-MPD, Menlo Park, CA, 94025, USA. twagner@stanford.edu.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>VA Health Economics Resource Center, 795 Willow Rd., 152-MPD, Menlo Park, CA, 94025</wicri:regionArea><wicri:noRegion>94025</wicri:noRegion></affiliation><affiliation wicri:level="2"><nlm:affiliation>Stanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford School of Medicine , Stanford, CA, USA. twagner@stanford.edu.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Stanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford School of Medicine , Stanford, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:33107005</idno><idno type="pmid">33107005</idno><idno type="doi">10.1007/s11606-020-06104-6</idno><idno type="wicri:Area/Main/Corpus">000025</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000025</idno><idno type="wicri:Area/Main/Curation">000025</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000025</idno><idno type="wicri:Area/Main/Exploration">000025</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Rethinking How We Measure Costs in Implementation Research.</title><author><name sortKey="Wagner, Todd H" sort="Wagner, Todd H" uniqKey="Wagner T" first="Todd H" last="Wagner">Todd H. Wagner</name><affiliation wicri:level="1"><nlm:affiliation>VA Health Economics Resource Center, 795 Willow Rd., 152-MPD, Menlo Park, CA, 94025, USA. twagner@stanford.edu.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>VA Health Economics Resource Center, 795 Willow Rd., 152-MPD, Menlo Park, CA, 94025</wicri:regionArea><wicri:noRegion>94025</wicri:noRegion></affiliation><affiliation wicri:level="2"><nlm:affiliation>Stanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford School of Medicine , Stanford, CA, USA. twagner@stanford.edu.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Stanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford School of Medicine , Stanford, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author></analytic><series><title level="j">Journal of general internal medicine</title><idno type="eISSN">1525-1497</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Hospitals and other health care delivery organizations are sometimes resistant to implementing evidence-based programs, citing unknown budgetary implications.</p></div><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>In this paper, I discuss challenges when estimating health care costs in implementation research.</p></div><div type="abstract" xml:lang="en"><p><b>DESIGN</b></p><p>A case study with intensive care units highlights how including fixed costs can cloud a short-term analysis.</p></div><div type="abstract" xml:lang="en"><p><b>PARTICIPANTS</b></p><p>None.</p></div><div type="abstract" xml:lang="en"><p><b>INTERVENTIONS</b></p><p>None.</p></div><div type="abstract" xml:lang="en"><p><b>MAIN MEASURES</b></p><p>Health care costs, charges and payments.</p></div><div type="abstract" xml:lang="en"><p><b>KEY RESULTS</b></p><p>Cost data should accurately reflect the opportunity costs for the organization(s) providing care. Opportunity costs are defined as the benefits foregone because the resources were not used in the next best alternative. Because there is no database of opportunity costs, cost studies rely on accounting data, charges, or payments as proxies. Unfortunately, these proxies may not reflect the organization's opportunity costs, especially if the goal is to understand the budgetary impact in the next few years.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Implementation researchers should exclude costs that are fixed in the time period of observation because these assets (e.g., space) cannot be used in the next best alternative. In addition, it is common to use costs from accounting databases where we implicitly assume health care providers are uniformly efficient. If providers are not operating efficiently, especially if there is variation in their efficiency, then this can create further problems. Implementation scientists should be judicious in their use of cost estimates from accounting data, otherwise research results can misguide decision makers.</p></div></front></TEI><pubmed><MedlineCitation Status="In-Data-Review" Owner="NLM"><PMID Version="1">33107005</PMID><DateRevised><Year>2020</Year><Month>11</Month><Day>10</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1525-1497</ISSN><JournalIssue CitedMedium="Internet"><Volume>35</Volume><Issue>Suppl 2</Issue><PubDate><Year>2020</Year><Month>Nov</Month></PubDate></JournalIssue><Title>Journal of general internal medicine</Title><ISOAbbreviation>J Gen Intern Med</ISOAbbreviation></Journal><ArticleTitle>Rethinking How We Measure Costs in Implementation Research.</ArticleTitle><Pagination><MedlinePgn>870-874</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1007/s11606-020-06104-6</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Hospitals and other health care delivery organizations are sometimes resistant to implementing evidence-based programs, citing unknown budgetary implications.</AbstractText><AbstractText Label="OBJECTIVE" NlmCategory="OBJECTIVE">In this paper, I discuss challenges when estimating health care costs in implementation research.</AbstractText><AbstractText Label="DESIGN" NlmCategory="METHODS">A case study with intensive care units highlights how including fixed costs can cloud a short-term analysis.</AbstractText><AbstractText Label="PARTICIPANTS" NlmCategory="METHODS">None.</AbstractText><AbstractText Label="INTERVENTIONS" NlmCategory="METHODS">None.</AbstractText><AbstractText Label="MAIN MEASURES" NlmCategory="METHODS">Health care costs, charges and payments.</AbstractText><AbstractText Label="KEY RESULTS" NlmCategory="RESULTS">Cost data should accurately reflect the opportunity costs for the organization(s) providing care. Opportunity costs are defined as the benefits foregone because the resources were not used in the next best alternative. Because there is no database of opportunity costs, cost studies rely on accounting data, charges, or payments as proxies. Unfortunately, these proxies may not reflect the organization's opportunity costs, especially if the goal is to understand the budgetary impact in the next few years.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Implementation researchers should exclude costs that are fixed in the time period of observation because these assets (e.g., space) cannot be used in the next best alternative. In addition, it is common to use costs from accounting databases where we implicitly assume health care providers are uniformly efficient. If providers are not operating efficiently, especially if there is variation in their efficiency, then this can create further problems. Implementation scientists should be judicious in their use of cost estimates from accounting data, otherwise research results can misguide decision makers.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Wagner</LastName><ForeName>Todd H</ForeName><Initials>TH</Initials><Identifier Source="ORCID">http://orcid.org/0000-0001-7625-3504</Identifier><AffiliationInfo><Affiliation>VA Health Economics Resource Center, 795 Willow Rd., 152-MPD, Menlo Park, CA, 94025, USA. twagner@stanford.edu.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Stanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford School of Medicine , Stanford, CA, USA. twagner@stanford.edu.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>RCS-17-154</GrantID><Agency>U.S. Department of Veterans Affairs</Agency><Country></Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>10</Month><Day>26</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Gen Intern Med</MedlineTA><NlmUniqueID>8605834</NlmUniqueID><ISSNLinking>0884-8734</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">budgets</Keyword><Keyword MajorTopicYN="N">cost-benefit analysis</Keyword><Keyword MajorTopicYN="N">costs and cost analysis</Keyword><Keyword MajorTopicYN="N">economic models</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2019</Year><Month>09</Month><Day>03</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>07</Month><Day>30</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>10</Month><Day>28</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>10</Month><Day>28</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>10</Month><Day>27</Day><Hour>5</Hour><Minute>48</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">33107005</ArticleId><ArticleId IdType="doi">10.1007/s11606-020-06104-6</ArticleId><ArticleId IdType="pii">10.1007/s11606-020-06104-6</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>États-Unis</li></country><region><li>Californie</li></region></list><tree><country name="États-Unis"><noRegion><name sortKey="Wagner, Todd H" sort="Wagner, Todd H" uniqKey="Wagner T" first="Todd H" last="Wagner">Todd H. Wagner</name></noRegion><name sortKey="Wagner, Todd H" sort="Wagner, Todd H" uniqKey="Wagner T" first="Todd H" last="Wagner">Todd H. Wagner</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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