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