quality systems

An APHL workgroup is collaborating with consultant Paul Speaker, associate professor at West Virginia University, to develop a tool to capture data that will provide return on investment( ROI) metrics. The ROI information will provide quantifiable outcomes that demonstrate the effectiveness and value of public health laboratory( PHL) services. PHLs can use this data to educate partners, stakeholders and policy makers about the contributions of PHLs to the public health system.

ROI is defined as the ratio of net benefits retrieved by total investment or costs. It can be used to document dollars saved in avoided treatment costs as a result of laboratory testing.

The study’ s key contribution is the framing of costs as laboratory level measures, including expenditure distributions, testing volume and staff’ s level of effort in a specific testing area. Laboratory level efficiency metrics are used to estimate the laboratory’ s ROI compared to published benefit analysis for a specific test area.

Methods

The project was initiated in 2015 with a review of missions, language, mandates, objectives, goals and key areas for initial measurement. Additionally, medical and health economics literature was reviewed for likely adverse events resulting from diseases / conditions tested at PHLs, costs of treatment and related social benefits. Data from PHL program testing, personnel and financials was then combined with APHL survey data to establish baseline metrics for the tool, which allows individual laboratories to be connected to data on the benefits received from each area of testing.

Study participants populated the tool with testing data for influenza, tuberculosis, PulseNet, newborn screening and Safe Drinking Water Act programs. Data entry in Excel was designed for ease of use. Participants entered data using refined definitions and counting techniques that ensured accuracy and consistency of data for comparison across laboratories. Initial aggregate data show examples of what a dollar invested in laboratory testing can save in avoided future treatment costs.

Participating institutions include six state public health laboratories( Utah, Arizona, Minnesota, New York-Wadsworth, New Hampshire and Iowa) and five local public health laboratories( Tulare, Monterey and Riverside Counties, California; Fairfax County, Virginia; Alaska Environmental).

Additional Uses of the ROI Data

In addition to demonstrating the value of PHLs, the ROI project offers insight into internal laboratory mechanisms. Laboratory leaders can examine a breakdown of factors leading to individual laboratory returns, such as the role of local economic forces, internal productivity and long-term laboratory investment decisions. Monitoring these metrics supports strategic and tactical decisions to optimize laboratory performance, maximize ROI and demonstrate the value of investing in PHLs.

These are preliminary figures, pending validation of the tool’ s inputs and calculations, and are intended to illustrate the range of ROI’ s that may be expected

Next Steps

Feedback from study participants has demonstrated the need for a more detailed user’ s guide, further clarification of definitions, guidance on the interpretation of the results and examples of how to utilize the information generated from the data. Next steps include recruiting more PHLs to provide their data, sharing the benefits and outcomes of using the tool at the 2017 APHL Annual Meeting, and eventually creating a system to allow PHLs to compare their individual data to the PHL community mean.

Also to be added is the option of evaluating data using quality adjusted life years( QALYs), a measure used in health economics to quantify cost-benefit decisions in healthcare. QALYs, the product of life expectancy and a quality metric associated with any health condition, are compared to the average quality of life of a person without an illness or condition and can further document the value of laboratory testing.

References 1. FORESIGHT Overview. http:// www. be. wvu. edu / forensic / foresight. htm

APHL Return on Investment Workgroup

Members:

• Christine Bean, New Hampshire

• Denise Lopez, Tulare County, CA

• Lorelei Kurimski, Iowa

• Bob Rej, New York-Wadsworth

• Paula Snippes Vagnone, Minnesota

• Victor Waddell, Arizona

Staff:

• Karen Breckenridge

• Deborah Kim

• Tina Su

• Sara Woldehanna

CDC Representative: John Ridderhof Consultant: Paul Speaker, West Virginia University