Abstract
BackgroundAudit and feedback is a common implementation strategy, but few studies describe its costs. ‘MyPractice’ is a province-wide audit and feedback initiative to improve prescribing in nursing homes. This study sought to estimate the costs of ‘MyPractice’ and assess whether the financial benefit of ‘MyPractice’ offsets those costs.MethodsWe conducted a costing study from the perspective of the Ontario government. Total cost of ‘MyPractice’ was calculated as the sum of the costs of producing and disseminating the reports (covering three report releases) which were obtained from Ontario Health staff interviews and document reviews. Return on investment (ROI) was calculated as the ratio of net cost-savings and the intervention cost. Cost savings were based on the effectiveness of ‘MyPractice’ derived from a published cohort study. Cost-savings attributable to ‘MyPractice’ were estimated from the changes in the rates of antipsychotics over time between physicians who signed up and viewed the reports and those who did not sign up to the reports.ResultsTotal intervention costs were C$223,691 (C$838 per physician and C$74,564 per release). Costs incurred during the development phase accounted for 74% of the total cost (C$166,117), while implementation costs for three report releases were responsible for 26% of the total costs (C$57,575). The ROI for every C$1 spent on the ‘MyPractice’ intervention was 1.02 (95% CI 0.51, 1.93) for three report releases.Conclusion‘MyPractice’ report offers a good return on investment and the value for money could improve with greater number of report releases.
Highlights
Audit and feedback is a common implementation strategy, but few studies describe its costs
The present study evaluates the cost and return on investment for an audit and feedback initiative, namely ‘MyPractice’, that addresses prescribing of high-risk medications among long-term care home residents in Ontario, Canada
Our study shows that ‘MyPractice’ offers a good return on investment, and the value for money could improve with greater number of report releases
Summary
Audit and feedback is a common implementation strategy, but few studies describe its costs. 20.7% of long-term care home residents are prescribed antipsychotics without concurrent psychiatric diagnosis in Canada [1]. Inappropriate use of these medications could increase risk of stroke, heart disease, and kidney failures which increase risk of premature death [1, 2]. An Australian study, for example, examining the impact of A&F on antipsychotics prescribing for schizophrenia showed that A&F was effective in changing prescribing rates towards recommended levels [6]. Another randomized control trial reported that the multi-strategic intervention consisting of A&F, including staff education and interdisciplinary reviews, resulted in a significant reduction in the proportion of long-term care home residents taking antipsychotics [7]
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