Smith, Mark W and Barnett, Paul G (2008): The role of economics in the QUERI program: QUERI Series. Published in: Implementation Science , Vol. 3, No. 20 (May 2008)
Download (263kB) | Preview
Background: The United States (U.S.) Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) has implemented economic analyses in single-site and multi-site clinical trials. To date, no one has reviewed whether the QUERI Centers are taking an optimal approach to doing so. Consistent with the continuous learning culture of the QUERI Program, this paper provides such a reflection. Methods: We present a case study of QUERI as an example of how economic considerations can and should be integrated into implementation research within both single and multi-site studies. We review theoretical and applied cost research in implementation studies outside and within VA. We also present a critique of the use of economic research within the QUERI program. Results: Economic evaluation is a key element of implementation research. QUERI has contributed many developments in the field of implementation but has only recently begun multisite implementation trials across multiple regions within the national VA healthcare system. These trials are unusual in their emphasis on developing detailed costs of implementation, as well as in the use of business case analyses (budget impact analyses). Conclusion: Economics appears to play an important role in QUERI implementation studies, only after implementation has reached the stage of multi-site trials. Economic analysis could better inform the choice of which clinical best practices to implement and the choice of implementation interventions to employ. QUERI economics also would benefit from research on costing methods and development of widely accepted international standards for implementation economics.
|Item Type:||MPRA Paper|
|Original Title:||The role of economics in the QUERI program: QUERI Series.|
|Keywords:||implementation science; cost analysis; cost-effectiveness; health care cost; health systems;|
|Subjects:||H - Public Economics > H5 - National Government Expenditures and Related Policies > H51 - Government Expenditures and Health
I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy; Regulation; Public Health
I - Health, Education, and Welfare > I1 - Health
|Depositing User:||Mark W Smith|
|Date Deposited:||08. Dec 2008 19:07|
|Last Modified:||20. Feb 2013 22:13|
1. McQueen L, Mittman BS, Demakis JG: Overview of the Veterans Health Administration (VHA) Quality Enhancement Research Initiative (QUERI). J Am Med Inform Assoc 2004, 11:339-393.
2. Demakis JG, McQueen L, Kizer KW, Feussner JR: Quality Enhancement Research Initiative (QUERI): collaboration between research and clinical practice. Medical Care 2000, 38:I17-25.
3. Stetler CB, Mittman BS, Francis J: Overview of the VA Quality Enhancement Research Initiative (QUERI) and QUERI theme articles: QUERI Series. Implementation Science 2008, 3:8.
4. Drummond M, Brown R, Fendrick AM, Fullerton P, Neumann P, Taylor R, Barbieri M, ISPOR Task Force: Use of pharmacoeconomics information – report of the ISPOR Task Force on Use of Pharmacoeconomic/Health Economic Information in Health-Care Decision Making. Value in Health 2003, 6(4):407-416.
5. Gold MR, Siegel JE, Russell LB, Weinstein MC: Cost-Effectiveness in Health and Medicine New York: Oxford University Press; 1996.
6. Drummond MF, Jefferson TO: Guidelines for authors and peer reviewers of economic submissions to the British Medical Journal. British Medical Journal 1996, 313:275-283.
7. McIntosh E: Economic evaluation of guideline implementation strategies. In Changing Professional Practice: Theory and Practice of Clinical Guidelines Implementation Edited by: Thorson T, Mäkelä M. Copenhagen: Danish Institute for Health Services Research and Development; 1999. [DSI Report, no. 99.05.]
8. Severens JL: Value for money of changing healthcare services? Economic evaluation of quality improvement. Qual Saf Health Care 2003, 12(5):366-371.
9. Eccles M, Grimshaw J, Campbell M, Ramsay C: Research designs for studies evaluating the effectiveness of change and improvement strategies. Qual Saf Health Care 2003, 12(1):47-52.
10. Severens JL, Martens JD, Wensing M: Economic evaluations of implementation strategies. In Improving Patient Care: The Implementation of Change in Clinical Practice Volume 20. Edited by: Grol R, Wensing M, Eccles M. Amsterdam: Elsevier; 2004.
11. Mason J, Freemantle N, Nazareth I, Eccles M, Haines A, Drummond M: When is it cost-effective to change the behavior of health professionals? JAMA 2001, 286:2988-92.
12. Mauskopf JA, Sullivan SD, Annemans L, Caro JJ, Mullins CD, Nuijten M, Orlewska E, Trueman P, Watkins J: "Report of the ISPOR Task Force on Good Research Practices – Budget Impact Analysis." Value in Health 2007, 10(5):336-347. forthcoming.
13. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 2004, 82:581-629.
14. Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C: Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technology Assessment 2004, 8(6):43-51.
15. Vale L, Thomas R, MacLennan G, Grimshaw J: Systematic review of economic evaluations and cost analyses of guideline implementation strategies. Eur J Health Econ 2007, 8(2):111-121.
16. Mauskopf JA, Earnshaw S, Mullins CD: Budget impact analysis: review of the state of the art. Expert Review of Pharmacoeconomics and Outcomes Research 2005, 5(1):65-79.
17. Jackson KC, Nahoopii R, Said Q, Dirani R, Brixner D: An employer-based cost-benefit analysis of a novel pharmacotherapy agent for smoking cessation. J Occup Environ Med 2007, 49(4):453-460.
18. Nicholson S, Pauly MV, Polsky D, Baase CM, Billotti GM, Ozminkowski RJ, Berger ML, Sharda CE: How to present the business case for healthcare quality to employers. Appl Health Econ Health Policy 2005, 4(4):209-218.
19. Hamilton S, McLaren S, Mulhall A: Assessing organizational readiness for change: use of diagnostic analysis prior to the implementation of a multidisciplinary assessment for acute stroke care. Implementation Science 2007, 2:21.
20. Gold M, Taylor EF: Moving research into practice: lessons from the US Agency for Healthcare Research and Quality's IDSRN program. Implementation Science 2007, 2:9.
21. Bradley EH, Webster TR, Baker D, Schlesinger M, Inouye SK, Barth MC, Lapane KL, Lipson D, Stone R, Koren MJ: Translating research into practice: speeding the adoption of innovative health care programs. In Commonwealth Fund Issue Brief, no. 724 New York: The Commonwealth Fund; 2004.
22. Fretheim A, Håvelsrud K, Oxman AD: Rational Prescribing in Primary care (RaPP): process evaluation of an intervention to improve prescribing of antihypertensive and cholesterollowering drugs. Implementation Science 2006, 1:19.
23. Gagnon MP, Sánchez E, Pons JMV: From recommendation to action: psychosocial factors influencing physician intention to use Health Technology Assessment (HTA) recommendations. Implementation Science 2006, 1:8.
24. Gravel K, Légaré F, Graham ID: Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals' perceptions. Implementation Science 2006, 1:16.
25. Stetler C, McQueen L, Demakis J, Mittman B: An evidence-based implementation program in the US Department of Veterans Affairs: The role of context and strategic management of change: QUERI Series. Implementation Science 2008, 3:.
26. Sales A, Smith J, Curran G, Kochevar L: Models, strategies, and tools. Theory in implementing evidence-based findings into health care practice. Journal of General Internal Medicine 2006, 21(Suppl 2):S43-S49.
27. Stetler CB, Legro MW, Rycroft-Malone J, Bowman C, Curran G, Guihan M, Hagedorn H, Pineros S, Wallace CM: Role of "external facilitation" in implementation of research findings: a qualitative evaluation of facilitation experiences in the Veterans Health Administration. Implementation Science 2006, 1:23.
28. Stetler CB, Legro MW, Wallace CM, Bowman C, Guihan M, Hagedorn H, Kimmel B, Sharp ND, Smith JL: The role of formative evaluation in implementation research and the QUERI experience. J Gen Intern Med 2006, 21(Suppl 2):S1-S8.
29. Kochevar LK, Yano EM: Understanding health care organization needs and context. Beyond performance gaps. J Gen Int Med 2006, 21(Suppl 2):S25-S29.
30. Hagedorn H, Hogan M, Smith JL, Bowman C, Curran GM, Espadas D, Kimmel B, Kochevar L, Legro MW, Sales AE: Lessons learned about implementing research evidence into clinical practice: experiences from VA QUERI. Journal of General Internal Medicine 2006, 21(Suppl 2):S21-S24.
31. Curran GM, Thrush CR, Smith JL, Owen RR, Ritchie M, Chadwick D: Implementing research findings into practice using clinical opinion leaders: barriers and lessons learned. Jt Comm J Qual Patient Saf 2005, 31(12):700-707.
32. Provenzale D: The cost-effectiveness of screening the average-risk population for colorectal cancer. Gastrointestinal Endoscopy Clinics of North America 2002, 12(1):93-109.
33. Barnett PG, Zaric G, Brandeau M: The cost-effectiveness of buprenorphine maintenance therapy for opiate addiction in the United States. Addiction 2001, 96:1267-1278.
34. Fearon W, Yeung A, Lee D, Yock P, Heidenreich P: The cost-effectiveness of measuring fractional flow reserve to guide coronary interventions. American Heart Journal 2003, 145:882-887.
35. Owens D, Edwards D, Schacter R, Kaplan E, Brookmeyer R: Costs and benefits of imperfect HIV vaccines: Implications for vaccine development and use. In Quantitative Evaluation of HIV Prevention Programs Edited by: Kaplan E, Brookmeyer R. New Haven: Yale University Press; 2002.
36. Sanders G, Bayoumi A, Sundaram V, Bilir S, Neukermans C, Rydzak C, Douglass L, Lazzeroni L, Holodniy M, Owens D: Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. NEJM 2005, 352:570-85.
37. Felker BL, Chaney E, Rubenstein LV, Bonner LM, Yano EM, Parker LE, Worley LL, Sherman SE, Ober S: Developing effective collaboration between primary care and mental health providers. Prim Care Companion J Clin Psychiatry 2006, 8(1):12-16.
38. Owen RR, Rubenstein LV, Chaney EF, Smith JL: Bringing evidence-based practices into regional and national use: The ReTIDES example. HSR&D National Meeting 2007 [http:// www.hsrd.research.va.gov/meetings/2007/ display_abstract.cfm?RecordID= 393].
39. Liu CF, Kirchner J, Fortney J, Perkins M, Ober S, Pyne J, Rubenstein L, Chaney E: What does it take to implement an evidence-based depression treatment in primary care? [abstract]. In 2005 Health Services Research and Development National Meeting Abstracts: Improving Care for Veterans with Chronic Illnesses Washington, DC: U.S. Department of Veterans Affairs; 2005.
40. Asch S, Gifford A, Goetz M: QUERI-HIV/Hepatitis Annual Report. Los Angeles, Calif.: VA Greater Los Angeles Healthcare System; 2006.
41. Goetz M, Bowman C, Hoang T, Anaya H, Osborn T, Gifford A, Asch S: Implementing and evaluating a regional strategy to improve testing rates in VA patients at risk for HIV, utilizing the QUERI process as a guiding framework: QUERI Series. Implementation Science 2008, 19(3):16.
42. Weaver FM, Goldstein B, Evans CT, Legro MW, LaVela S, Smith B, Miskevics S, Hammond MC: Influenza vaccination among veterans with spinal cord injury: Part 2. Increasing vaccination rates. Journal of Spinal Cord Medicine 2003, 26(3):210-218.
43. Weaver FM, Smith B, LaVela S, Wallace C, Evans CT, Hammond B, Goldstein B: Interventions to increase influenza vaccination rates in veterans with spinal cord injuries and disorders. Journal of Spinal Cord Medicine 2007, 30(1):10-19.
44. Neumann PJ: Why don't Americans use cost-effectiveness analysis? The American Journal of Managed Care 2004, 10:308-312.
45. Luft HS: Benefit-cost analysis and public policy implementation: from normative to positive analysis. Public Policy 1976, 24:437-462.
46. Drummond MF, Stoddart GL: Economic analysis and clinical trials. Control Clin Trials 1984, 5(2):115-128.
47. QUERI Implementation Guide [http:// www.hsrd.research.va.gov/QUERI/implementation/]
48. Luce BR, Manning WG, Siegel JE, Lipscomb J: Estimating Costs in Cost-Effectiveness Analysis. In Cost-Effectiveness in Health and Medicine Edited by: Gold MR, Siegel JE, Russell LB, Weinstein MC. New York: Oxford University Press; 1996.
49. Prosser LA, Kaplan JP, Neumann PJ, Weinstein MC: Barriers to using cost-effectiveness analysis in managed care decision making. American Journal of Managed Care 2000, 6(2):173-179.
50. Lyons SS, Tripp-Reimer T, Sorofman BA, DeWitt JE, BootsMiller BJ, Vaughn TE, Doebbeling BN: Information technology for clinical guideline implementation: Perceptions of multidisciplinary stakeholders. JAMIA 2005, 12:64-71.
51. Bloom BS: Use of formal benefit/cost evaluations in health system decision making. The American Journal of Managed Care 2004, 10:329-335.
52. Barnett PG: Determination of VA health care costs. Med Care Res Rev 2003, 60(3 Supp):124S-141S.