Phillips Victoria L, Xue Ashley, Castillo Marné, Santiago Dalia, Wimbly Taylor, Hightow-Weidman Lisa B, Stephenson Rob, Bauermeister José A
Rollins School of Public Health of Emory University, 1518 Clifton Road, Room 614, Atlanta, GA, 30322, USA.
Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA.
Health Econ Rev. 2023 Jun 2;13(1):34. doi: 10.1186/s13561-023-00447-6.
Cultural competency has been identified as a barrier to lesbian, gay, bisexual and transgender (LGBT) populations seeking care. Mystery shopping has been widely employed in the formal health care sector as a quality improvement (QI) tool to address specific client needs. The approach has had limited use in community-based organizations due in part to lack of knowledge and resource requirement concerns. Several mystery shopping initiatives are now being implemented which focus on the LGBT population with the goal of reducing barriers to accessing care. One subset targets men who have sex with men (MSM) to increase uptake of human immunodeficiency virus (HIV) testing. No study investigates the costs of these initiatives. Get Connected was a randomized control trial with the objective of increasing uptake of HIV-prevention services among young men who have sex with men (YMSM) through use of a resource-locator application (App). The initial phase of the trial employed peer-led mystery shopping to identify culturally competent HIV testing sites for inclusion in the App. The second phase of the trial randomized YMSM to test the efficacy of the App. Our objective was to determine the resource inputs and costs of peer-led mystery shopping to identify clinics for inclusion in the App as costs would be critical in informing possible adoption by organizations and sustainability of this model.
Through consultation with study staff, we created a resource inventory for undertaking the community-based, peer-led mystery shopping program. We used activity-based costing to price each of the inputs. We classified inputs as start-up and those for on-going implementation. We calculated costs for each category, total costs and cost per mystery shopper visit for the four-month trial and annually to reflect standard budgeting periods for data collected from September of 2019 through September of 2020.
Recruitment and training of peer mystery shoppers were the most expensive tasks. Average start-up costs were $10,001 (SD $39.8). Four-month average implementation costs per visit were $228 (SD $1.97). Average annual implementation costs per visit were 33% lower at $151 (SD $5.60).
Peer-led, mystery shopping of HIV-testing sites is feasible, and is likely affordable for medium to large public health departments.
文化能力已被视为女同性恋、男同性恋、双性恋和跨性别者（LGBT）群体寻求医疗服务的障碍。神秘顾客调查已在正规医疗保健部门广泛用作质量改进（QI）工具，以满足特定客户需求。由于部分原因是缺乏知识和对资源需求的担忧，该方法在社区组织中的应用有限。现在正在实施一些针对LGBT群体的神秘顾客调查举措，目标是减少获得医疗服务的障碍。其中一个子集针对男男性行为者（MSM），以提高艾滋病毒（HIV）检测的接受率。没有研究调查这些举措的成本。“建立联系”是一项随机对照试验，目的是通过使用资源定位应用程序（应用程序）提高男男性行为青年（YMSM）对艾滋病毒预防服务的接受率。试验的初始阶段采用同伴主导的神秘顾客调查，以确定具有文化能力的艾滋病毒检测地点纳入应用程序。试验的第二阶段将YMSM随机分组，以测试应用程序的功效。我们的目标是确定同伴主导的神秘顾客调查的资源投入和成本，以确定纳入应用程序的诊所，因为成本对于告知组织可能的采用情况以及该模式的可持续性至关重要。
通过与研究人员协商，我们创建了一个用于开展基于社区的、同伴主导的神秘顾客调查项目的资源清单。我们使用作业成本法对每个投入进行定价。我们将投入分为启动投入和持续实施投入。我们计算了四个月试验期和每年每个类别的成本、总成本以及每次神秘顾客访问的成本，以反映从2019年9月到2020年9月收集数据的标准预算期。
同伴神秘顾客的招募和培训是最昂贵的任务。平均启动成本为10,001美元（标准差39.8美元）。每次访问的四个月平均实施成本为228美元（标准差1.97美元）。每次访问的平均年度实施成本低33%，为151美元（标准差5.60美元）。
同伴主导的艾滋病毒检测地点神秘顾客调查是可行的，对于中大型公共卫生部门来说可能是负担得起的。
