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Persaud A, Smith NR, Lindros J, Salmon J, Ventura G, Perkins M, Taveras EM, Fiechtner L, Simione M. Assessing the market viability of a packaged intensive health behavior and lifestyle treatment. Transl Behav Med 2023; 13:ibad074. [PMID: 38066667 PMCID: PMC10724182 DOI: 10.1093/tbm/ibad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
In the USA, more than 14 million children are impacted by obesity. Despite intensive health behavior and lifestyle treatments being found effective, gaps exist in moving these interventions into widespread use. Focusing on market viability could improve the dissemination and sustainment of interventions. The purpose of this paper is to outline the process and results of our market viability assessment for the Healthy Weight Clinic (HWC), a Centers for Disease Control and Prevention-recognized Family Health Weight Program. We conducted a market viability assessment using the Speeding Research-test INTerventions (SPRINT) program to gain insights into the commercialization and marketplace for the HWC. Through the process of customer discovery, we interviewed 50 stakeholders to test our hypotheses pertaining to our business model. Key takeaways were the need for packaged interventions that offer support and training for providers, and interventions that are multidisciplinary and located within the medical home. We also learned that (i) the intervention goals must align with the healthcare organization's performance metrics; (ii) services need to be reimbursable; and (iii) the importance of understanding different customer segments (i.e. program users vs. organization decision-makers) and their unique needs. The market viability assessment is a critical step to transforming the HWC into a viable commercial product. The process we have outlined is replicable by others and by encouraging other teams to design for dissemination we can increase the number of evidence-based, packaged IHBLTs available to children with obesity.
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Affiliation(s)
- Alicia Persaud
- Division of General Academic Pediatrics, Mass General for Children, Boston, MA, USA
| | - Natalie Riva Smith
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Jeanne Lindros
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Itasca, IL, USA
| | - Jeremiah Salmon
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Itasca, IL, USA
| | - Giustina Ventura
- Division of General Academic Pediatrics, Mass General for Children, Boston, MA, USA
| | - Meghan Perkins
- Division of General Academic Pediatrics, Mass General for Children, Boston, MA, USA
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Mass General for Children, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Lauren Fiechtner
- Division of General Academic Pediatrics, Mass General for Children, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology and Nutrition, Massachusetts General Hospital for Children, Boston, MA, USA
| | - Meg Simione
- Division of General Academic Pediatrics, Mass General for Children, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Smith NR, Simione M, Farrar-Muir H, Granadeno J, Moreland JW, Wallace J, Frost HM, Young J, Craddock C, Sease K, Hambidge SJ, Taveras EM, Levy DE. Costs to Implement a Pediatric Weight Management Program Across 3 Distinct Contexts. Med Care 2023; 61:715-725. [PMID: 37943527 PMCID: PMC10478682 DOI: 10.1097/mlr.0000000000001891] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND The Connect for Health program is an evidence-based program that aligns with national recommendations for pediatric weight management and includes clinical decision support, educational handouts, and community resources. As implementation costs are a major driver of program adoption and maintenance decisions, we assessed the costs to implement the Connect for Health program across 3 health systems that primarily serve low-income communities with a high prevalence of childhood obesity. METHODS We used time-driven activity-based costing methods. Each health system (site) developed a process map and a detailed report of all implementation actions taken, aligned with major implementation requirements (eg, electronic health record integration) or strategies (eg, providing clinician training). For each action, sites identified the personnel involved and estimated the time they spent, allowing us to estimate the total costs of implementation and breakdown costs by major implementation activities. RESULTS Process maps indicated that the program integrated easily into well-child visits. Overall implementation costs ranged from $77,103 (Prisma Health) to $84,954 (Denver Health) to $142,721 (Massachusetts General Hospital). Across implementation activities, setting up the technological aspects of the program was a major driver of costs. Other cost drivers included training, engaging stakeholders, and audit and feedback activities, though there was variability across systems based on organizational context and implementation choices. CONCLUSIONS Our work highlights the major cost drivers of implementing the Connect for Health program. Accounting for context-specific considerations when assessing the costs of implementation is crucial, especially to facilitate accurate projections of implementation costs in future settings.
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Affiliation(s)
- Natalie Riva Smith
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital
| | - Meg Simione
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Haley Farrar-Muir
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children
| | - Jazmin Granadeno
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children
| | | | | | - Holly M. Frost
- Department of Pediatrics, Denver Health
- Center for Health Systems Research, Denver Health, Denver
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | | | - Cassie Craddock
- Department of Ambulatory Quality and Reliability, Prisma Health
| | - Kerry Sease
- Department of Pediatrics, University of South Carolina School of Medicine
- Prisma Health Children’s Hospital, Greenville, SC
| | - Simon J. Hambidge
- Ambulatory Care Services, Denver Health, Denver
- Harvard Medical School, Boston, MA
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Douglas E. Levy
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital
- Harvard Medical School, Boston, MA
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Harris A, Jordan N, Carroll AJ, Graham AK, Wilson C, Wilson FA, Berkel C, Smith JD. A budget impact analysis of cost to implement a whole child health focused, family-based intervention in primary care for children with elevated BMI. Implement Sci Commun 2023; 4:59. [PMID: 37277878 DOI: 10.1186/s43058-023-00429-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/16/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Although the cost of implementing evidence-based interventions (EBIs) is a key determinant of adoption, lack of cost information is widespread. We previously evaluated the cost of preparing to implement Family Check-Up 4 Health (FCU4Health), an individually tailored, evidence-based parenting program that takes a whole child approach, with effects on both behavioral health and health behavior outcomes, in primary care settings. This study estimates the cost of implementation, including preparation. METHODS We assessed the cost of FCU4Health across the preparation and implementation phases spanning 32 months and 1 week (October 1, 2016-June 13, 2019) in a type 2 hybrid effectiveness-implementation study. This family-level randomized controlled trial took place in Arizona with n = 113 predominantly low-income, Latino families with children ages > 5.5 to < 13 years. Using electronic cost capture and time-based activity-driven methods, budget impact analysis from the perspective of a future FCU4Health adopting entity-namely, ambulatory pediatric care clinicians-was used to estimate the cost of implementation. Labor costs were based on 2021 Bureau of Labor Statistics Occupational Employment Statistics, NIH-directed salary cap levels or known salaries, plus fringe benefits at a standard rate of 30%. Non-labor costs were based on actual amounts spent from receipts and invoices. RESULTS The cost of FCU4Health implementation to 113 families was $268,886 ($2380 per family). Actual per family cost varied widely, as individual tailoring resulted in families receiving a range of 1-15 sessions. The estimated cost of replicating implementation for future sites ranged from $37,636-$72,372 ($333-$641 per family). Using our previously reported preparation costs (i.e., $174,489; $1544 per family), with estimated replication costs of $18,524-$21,836 ($164-$193 per family), the total cost of delivering FCU4Health was $443,375 ($3924 per family), with total estimated replication costs of $56,160-$94,208 ($497-$834 per family). CONCLUSIONS This study provides a baseline for costs associated with implementation of an individually tailored parenting program. Results provide critical information for decision makers and a model for future economic analysis and can be used to inform optimization thresholds for implementation and, when necessary, benchmarks for program adaptation to promote scale-up. TRIAL REGISTRATION This trial was prospectively registered on January 6, 2017, at ClinicalTrials.gov (NCT03013309).
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Affiliation(s)
- Alexandra Harris
- Health Sciences Integrated PhD Program, Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Allison J Carroll
- Center for Prevention Implementation Methodology, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrea K Graham
- Center for Behavioral Intervention Technologies, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Fernando A Wilson
- Department of Population Health Sciences, University of Utah Intermountain Healthcare, Spencer Fox Eccles School of Medicine, College of Social and Behavioral Science Department of Economics, Matheson Center for Health Care Studies, University of Utah, Salt Lake City, UT, USA
| | - Cady Berkel
- Population Health & Integrated Behavioral Health, College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Justin D Smith
- Department of Population Health Sciences, University of Utah Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Smith NR, Knocke KE, Hassmiller Lich K. Using decision analysis to support implementation planning in research and practice. Implement Sci Commun 2022; 3:83. [PMID: 35907894 PMCID: PMC9338582 DOI: 10.1186/s43058-022-00330-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 07/12/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The process of implementing evidence-based interventions, programs, and policies is difficult and complex. Planning for implementation is critical and likely plays a key role in the long-term impact and sustainability of interventions in practice. However, implementation planning is also difficult. Implementors must choose what to implement and how best to implement it, and each choice has costs and consequences to consider. As a step towards supporting structured and organized implementation planning, we advocate for increased use of decision analysis. MAIN TEXT When applied to implementation planning, decision analysis guides users to explicitly define the problem of interest, outline different plans (e.g., interventions/actions, implementation strategies, timelines), and assess the potential outcomes under each alternative in their context. We ground our discussion of decision analysis in the PROACTIVE framework, which guides teams through key steps in decision analyses. This framework includes three phases: (1) definition of the decision problems and overall objectives with purposeful stakeholder engagement, (2) identification and comparison of different alternatives, and (3) synthesis of information on each alternative, incorporating uncertainty. We present three examples to illustrate the breadth of relevant decision analysis approaches to implementation planning. CONCLUSION To further the use of decision analysis for implementation planning, we suggest areas for future research and practice: embrace model thinking; build the business case for decision analysis; identify when, how, and for whom decision analysis is more or less useful; improve reporting and transparency of cost data; and increase collaborative opportunities and training.
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Affiliation(s)
- Natalie Riva Smith
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, 02115, USA.
| | - Kathleen E Knocke
- Department of Health Policy and Management, Gillings School of Global Public Health, UNC Chapel Hill, Chapel Hill, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, UNC Chapel Hill, Chapel Hill, USA
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