Abstract
Having established the scope and perspective of the analysis and determined the nature and structure of your QI intervention, it is now possible to estimate, in a prospective analysis, or summarize, in a retrospective one, the costs and benefits associated with the quality improvement activities. The difficulty of this task will vary significantly from project to project and will depend on the type of intervention, the setting, the available data, and other factors, some of which will be uncontrollable. However, creating the general framework allows for the determination of what costs and benefits are relevant and of interest. In this chapter, we will explore costs and benefits in some detail, including examining their potential sources and discussing how to quantify them and then aggregate them in a meaningful way. As mentioned in the previous chapter, the ability to measure and monetize costs and benefits will be closely linked to the ability to measure and quantify quality, given how quality, costs, and benefits have been defined for the given situation. We must continue to consider the economic implications of the intervention in concert with considerations of quality measurements and the demonstration of their changes.
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Notes
- 1.
These are sometimes referred to as “intangibles,” but I believe it is more useful to classify them based on whether they are measurable, monetizable, and attributable to the intervention as a way to better understand why they can or cannot be quantified or included in the ROI calculation.
- 2.
Many resources on ROI will classify benefits as either “direct” or “indirect.” I have avoided this language here because I think it can be confusing. Typically, “direct benefits ” refer to those that are measurable and monetizable, and “indirect benefits ” are really intangible benefits. But, I think considering whether benefits are measurable, monetizable, and directly attributable provides more specific guidance about whether or not to include them in the analysis, and how to do so.
- 3.
That does not mean that it is necessarily not a result of the intervention, but to include the benefit of increased ED efficiency in the ROI calculation, one would have to demonstrate how they are linked.
- 4.
A discussion regarding why rates per time at risk are more universally useful than counts and percentages follows shortly.
- 5.
A template for abstracting this type of information is provided in a later chapter.
- 6.
The details of this are not crucial here: You could just as easily perform this exercise by assuming a weekly incidence of 5% versus 3.5% instead of assuming an exponential distribution.
- 7.
Through algebra, we can show that if the interest rate is set equal to d/(1 − d) where d is the discount rate, then the two formulas would produce the same result for PV; in our example of a discount rate of 3.5%, that formula indicates that an interest rate of 3.627% is roughly equivalent.
References
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Boustani M, Azar J, Solid CA (2020) Agile implementation: a model for implementing evidence-based healthcare solutions into real-world practice to achieve sustainable change. Morgan James Publishing, New York
Sashegyi A, Ferry D (2017) On the interpretation of the hazard ratio and communication of survival benefit. Oncologist 22(4):484–486. https://doi.org/10.1634/theoncologist.2016-0198
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Solid, C.A. (2020). Costs and Benefits. In: Return on Investment for Healthcare Quality Improvement. Springer, Cham. https://doi.org/10.1007/978-3-030-46478-3_4
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