Levin Carol E, Tauscher Justin, Meller Suzanne, Brian Rachel M, Buck Benjamin E, Ben-Zeev Dror
Department of Global Health (Levin) and Department of Psychiatry and Behavioral Sciences (Tauscher, Brian, Buck, Ben-Zeev), University of Washington, Seattle; Little Otter Health, San Francisco (Meller).
Psychiatr Serv. 2024 Apr 1;75(4):357-362. doi: 10.1176/appi.ps.20230140. Epub 2023 Oct 26.
This study aimed to compare the costs of two implementation models for the mobile health (mHealth) intervention FOCUS in community mental health settings. The external facilitation (EF) approach uses a hub-and-spoke model, in which a central specialist provides support to clinicians and clients at multiple agencies. With the internal facilitation (IF) approach, frontline clinical staff at each center are trained to serve as their organization's local specialists.
Financial and economic cost data were collected in the context of a hybrid type 3 effectiveness-implementation trial by using a mixed-methods, top-down expenditure analysis with microcosting approaches. The analysis compared the incremental costs of both models and the costs of successfully engaging clients (N=210) at 20 centers. Costs were characterized as start-up or recurrent (personnel, supplies, contracted services, and indirect costs).
The average annual financial cost per site was $23,517 for EF and $19,118 for IF. EF yielded more FOCUS users at each center, such that the average monthly financial costs were lower for EF ($167 per client [N=129]) than for IF ($177 per client [N=81]). When using a real-world scenario based on economic costs and a lower organizational indirect rate, the average monthly cost per client was $73 for EF and $59 for IF. Both models reflected substantial cost reductions (about 50%) relative to a previous deployment of FOCUS in a clinical trial.
Compared with IF, EF yielded more clients who received mHealth at community mental health centers and had comparable or lower costs.
本研究旨在比较移动健康（mHealth）干预措施FOCUS在社区心理健康环境中的两种实施模式的成本。外部促进（EF）方法采用中心辐射模式，即由一名核心专家为多个机构的临床医生和客户提供支持。采用内部促进（IF）方法时，每个中心的一线临床工作人员会接受培训，担任其所在机构的本地专家。
在一项混合型3期有效性-实施试验中，通过使用混合方法、自上而下的支出分析和微观成本计算方法收集财务和经济成本数据。该分析比较了两种模式的增量成本以及在20个中心成功吸引客户（N = 210）的成本。成本分为启动成本或经常性成本（人员、物资、外包服务和间接成本）。
EF模式下每个站点的平均年度财务成本为23,517美元，IF模式为19,118美元。EF模式在每个中心吸引的FOCUS用户更多，因此EF模式的平均每月财务成本（每位客户167美元 [N = 129]）低于IF模式（每位客户177美元 [N = 81]）。在基于经济成本和较低组织间接费率的实际场景中，EF模式下每位客户的平均每月成本为73美元，IF模式为59美元。与之前在一项临床试验中部署FOCUS相比，两种模式的成本均大幅降低（约50%）。
与IF模式相比，EF模式在社区心理健康中心吸引了更多接受mHealth服务的客户，且成本相当或更低。
