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Implementation Science at UW

Keywords: time and motion

✪ Costs of implementing and sustaining enhanced collaborative care programs involving community partners

Authors:

Theresa J. Hoeft, Heather Wilcox, Ladson Hinton & Jürgen Unützer

University of Washington affiliated authors are displayed in bold.

Published: April 2019

Read the full text in the open access journal Implementation Science

 

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Abstract:

Background

Collaborative care is an evidence-based program for treating depression in primary care. We sought to expand this model by recruiting clinics interested in incorporating community partners (i.e., community-based organizations (CBO) and/or family members) in the care team. Seven sites implemented evidence-based collaborative care programs with community partners while collecting information on costs of implementing and sustaining programs.

Methods

Sites retrospectively collected data on planning and implementation costs with technical assistance from study researchers. Sites also prospectively collected cost of care activities over a 1-month period once the program was implemented to determine resources needed to sustain programs. Personnel salary costs were adjusted, adding 30% for benefits and 30% for administrative overhead.

Results

The programs implemented varied considerably in staffing, involvement of care partners, and allocation of costs. Total planning and implementation costs varied from $39,280 to $60,575. The largest implementation cost category involved workflow development and ranged from $16,325 to $31,375 with the highest costs in this category attributed to the most successful implementation among clinic-CBO programs. Following implementation, cost per patient over the 1-month period ranged from $154 to $544. Ongoing strategic decision-making and administrative costs, which were included in cost of care, ranged from $284 to $2328 for the month.

Conclusions

Sites implemented collaborative care through differing partnerships, staffing, and related costs. Costs to implement and sustain programs developed in partnership are often not collected but are crucial to understanding financial aspects of developing sustainable partnerships. Assessing such costs is feasible and can inform future partnership efforts.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

✪ Clinic flow for STI, HIV, and TB patients in an urban infectious disease clinic offering point-of-care testing services in Durban, South Africa

Authors:

Katrina J. Stime, Nigel Garrett, Yukteshwar Sookrajh, Jienchi Dorward, Ntuthu Dlamini, Ayo Olowolagba, Monisha
Sharma, Ruanne V. Barnabas and Paul K. Drain

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: May 2018

Read the full text in the open access journal BMC Health Services Research
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Abstract:

Background

Many clinics in Southern Africa have long waiting times. The implementation of point-of-care (POC) tests to accelerate diagnosis and improve clinical management in resource-limited settings may improve or worsen clinic flow and waiting times. The objective of this study was to describe clinic flow with special emphasis on the impact of POC testing at a large
urban public healthcare clinic in Durban, South Africa.

Methods

We used time and motion methods to directly observe patients and practitioners. We created patient flow maps and recorded individual patient waiting and consultation times for patients seeking STI, TB, or HIV care. We conducted semi-structured interviews with 20 clinic staff to ascertain staff opinions on clinic flow and POC test implementation.

Results

Among 121 observed patients, the total number of queues ranged from 4 to 7 and total visit times ranged from 0:14 (hours:minutes) to 7:38. Patients waited a mean of 2:05 for standard-of-care STI management, and approximately 4:56 for STI POC diagnostic testing. Stable HIV patients who collected antiretroviral therapy refills waited a mean of 2:42 in the standard queue and 2:26 in the fast-track queue. A rapid TB test on a small sample of patients with the Xpert MTB/RIF assay and treatment initiation took a mean of 6:56, and 40% of patients presenting with TB-related symptoms were asked to return for an additional clinic visit to obtain test results. For all groups, the mean clinical assessment time with a nurse
or physician was 7 to 9 min, which accounted for 2 to 6% of total visit time. Staff identified poor clinic flow and personnel shortages as areas of concern that may pose challenges to expanding POC tests in the current clinic environment.

Conclusions

This busy urban clinic had multiple patient queues, long clinical visits, and short clinical encounters. Although POC testing ensured patients received a diagnosis sooner, it more than doubled the time STI patients spent at the clinic and did not result in same-day diagnosis for all patients screened for TB. Further research on implementing POC testing efficiently into care pathways is required to make these promising assays a success.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

Costs of integrating cervical cancer screening at an HIV clinic in Kenya

Authors:

Elisabeth L. Vodicka, Joseph B. Babigumira, Marita R. Mann, Rose J. Kosgei, Fan Lee, Nelly R. Mugo, Timothy C. Okech, Samah R. Sakr, Louis P. Garrison Jr., Michael H. Chung

University of Washington affiliated authors are displayed in bold.

Subscription Required for Full Text Access

Published: October 2016

Read the full text in the subscription access International Journal of Gynecology & Obstetrics