Estimating the Cost and Cost Savings of Community Partners in Care

CTSI CERP Monthly Meeting

September 20, 2012

Bowen Chung, James Gilmore, Kenneth Wells,

Elizabeth Dixon, Michael McCreary, Loretta Jones, Michael Ong

Background

• Depression is the largest cause of adult disability in the U.S.

• Collaborative Care approaches for depression have been shown to improve quality, access and outcomes for minorities

• Community Partners in Care is a group level, randomized, comparative effectiveness trial of 2 approaches for disseminating and implementing collaborative care for depression in Los Angeles (PI Wells) – 1) Resources for Services (RS): low impact technical assistance approach – 1

day training and webinars on different components of collaborative care

– 2) Community Engagement and Planning (CEP): 4 month planning and network building approach to adapt, train and to implement collaborative

• 2 communities (Hollywood & South Los Angles), 95 programs (46 RS, 49 CEP); providers and administrators (312 enrolled in surveys or participated in trainings); clients (1018 at baseline and 6 months)

Research Question

• To estimate the costs of the CEP and RS interventions

• To estimate the differential impact of RS and CEP on cost of client services utilization in different service sectors in the study (health, mental health, substance abuse, social services, and other community programs).

Methods

• Community Partnered Participatory approach

• Monthly workgroup meetings with partners from Healthy African American Families II, Behavioral Health Services,

• Data Sources • Survey

– Client survey data, baseline, 6, & 12 month (n=1018)

– Provider and administrator survey data (n=536)

– Provider and administrator training data (n=312)

• Cost

– CMS : DRG codes and payments for inpatient stays

– AMA: CPT codes and payment for medical and mental health procedures

– National Bureau of Labor Statistics – wages for non-healthcare sector providers

Methods

• Analytic Outcomes – between RS and CEP – Quality adjusted life year (QALY) based on SF-12

– Days with depression

– Employment, days of work missed due to illness for those employed

– Intervention costs

– Total Healthcare costs (health, mental health, substance abuse)

– Total non-healthcare costs (social services, faith-based, parks, senior centers)

• Variables

– Independent variable: Intervention status (RS or CEP)

– Baseline disorder status

– Co-variates – age, gender, >=3 chronic conditions, education, race, family poverty, 12-month alcohol abuse and drug abuse, 12 month depressive disorder, and community.

Outcomes

• Progress to Date – Collecting and assigning cost data – services utilization, program costs

• Academic outcomes

– Manuscript on cost and cost-effectiveness

• Participatory research outcomes – Community – academic workgroups

– Community conferences / Knowledge transfer

• Policy related outcomes – Presentations to local, state, and national policy makers

CERP Aims Addressed

• Aim 1 – Promote and sustain bidirectional knowledge sharing between community and academia

• Aim 2- Strengthen community infrastructure for sustainable partnered research

• Aim 3 – Drive innovation in community engagement that accelerates the volume and impact of partnered research in diverse communities

• Aim 4 – Build health services research methods into partnerships to accelerate design, production, and wide adoption of evidence-based practice and behavior

Timeline

May 2012

June 2012

July 2012

August 2012

September 2012

October 2012

November 2012

December 2012

January 2013

February 2013

Workgroup x x x x x x x x x x

Analysis x x x x x x x x x x

Conference x

Manuscripts x

Added-Value from CTSI Funding

• Research Assistant

• Payments for community participants to be active in the process

• CPIC and partners ability to participate in the CTSI CERP core and share / learn from other projects

Next Steps

• Continue assigning costs and analysis

• In analyses, consider costs from the following perspectives: societal, healthcare, non-healthcare, community, and client

• Continue to engage the community around data analysis – especially in areas where costs may not be known or well-documented, especially outside of healthcare settings

• Also engage community partners to help frame the presentation for the community conference

• Draft of manuscript by Feb or March 2012