"Public health officials, policymakers, insurers and healthcare entities must make difficult decisions about which programs to support or implement. Understanding cost and quality improvement is a critical component of this decision-making process," John Fontanesi, Ph.D., and colleagues say.
Auditing and feedback systems and related software were the most expensive part of the recommended upgrades, the researchers found. But they said costs ran high in clinics where children's immunization records were not available electronically, leading to laborious searches through paper files for audit data.
It is unclear whether a clinic's funding for immunizations is enough to cover the current cost, Fontanesi says, adding that "it is unlikely to cover the costs of practice improvement."
Until new funding opportunities are made available, "this essential preventive service will continue to rely on the good intentions and financial resources of the facilities providing the service," he adds.
The researchers calculated improvement costs using data from 15 clinics in San Diego County that primarily serve patients at risk for low immunization coverage. The clinics included hospitals, private practices and community clinics.
Some of the clinics chose to implement the immunization recommendations throughout their system, while others emphasized making the changes at the level of individual doctors. The costs were "remarkably constant" in each case but the changes were more lasting when implemented throughout the entire system, Fontanesi and colleagues concluded.
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Contact: John Fontanesi
jfontanesi@ucsd.edu
Center for the Advancement of Health
15-Dec-2003