Department of Health Services Research and Administration and Nebraska Public Health Practice-Based Research Network, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska (Drs Chen and Palm); and Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska (Drs Wilson and Mss Gregg, Gupta, and Bekmuratova).
J Public Health Manag Pract. 2018 Mar/Apr;24(2):164-171. doi: 10.1097/PHH.0000000000000552.
To demonstrate an approach to measuring the cost and value of quality improvement (QI) implementation in local health departments (LHDs).
We conducted cost estimation for 4 LHD QI projects and return-on-investment (ROI) analysis for 2 selected LHD QI projects.
Four Nebraska LHDs varying in rurality and jurisdiction size.
Total costs, unit costs, incremental cost-effectiveness ratios, and ROI.
The 4 QI projects vary significantly in their cost estimates. Estimated ROI ratios for 2 QI projects predicted significant savings in health care utilization for respective program participants. A QI project focused on improving breastfeeding rates in WIC (women, infants, and children) clients had a predicted ROI ratio of 3230% and a QI project for improving participation in a Chronic Disease Self-Management Program would need only 34 new participants to have a positive ROI.
We demonstrated how data can be collected and analyzed for cost estimation and ROI analysis to quantify the economic value of QI for LHDs. Our ROI analysis shows that QI initiatives have great potential to enhance the value of LHDs' public health services. A better understanding of the costs and value of QI will enable LHDs to appropriately allocate and utilize their limited resources for suitable QI initiatives.
展示一种衡量地方卫生部门（LHD）质量改进（QI）实施成本和价值的方法。
我们对 4 个 LHD 的 QI 项目进行了成本估算，并对 2 个选定的 LHD QI 项目进行了投资回报率（ROI）分析。
4 个内布拉斯加州 LHD，其农村程度和管辖范围大小各不相同。
总成本、单位成本、增量成本效益比和 ROI。
4 个 QI 项目的成本估算差异很大。对 2 个 QI 项目的预计 ROI 比率预测了各自项目参与者在医疗保健利用方面的显著节省。一个专注于提高 WIC（妇女、婴儿和儿童）客户母乳喂养率的 QI 项目预计 ROI 比率为 3230%，而一个旨在提高参与慢性病自我管理计划的 QI 项目只需新增 34 名参与者即可实现正 ROI。
我们展示了如何收集和分析数据以进行成本估算和 ROI 分析，从而量化 QI 对 LHD 的经济价值。我们的 ROI 分析表明，QI 计划具有增强 LHD 公共卫生服务价值的巨大潜力。更好地了解 QI 的成本和价值将使 LHD 能够适当地分配和利用其有限的资源用于合适的 QI 计划。
