learning objectives describe the use of the outcomes impact analysis model to assess economic impact...
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Learning Objectives
• Describe the use of the Outcomes Impact Analysis model to assess economic impact of a CME activity
• Discuss the potential role of Outcomes Impact Analysis modeling in CME practice
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What We’ve Been Hearing…
• “How do I convey the value of CME to non-CME administrators?”
• “I need to summarize an entire year of outcomes in a condensed format.”
• “I’ve been asked to justify my continuing medical education budget.”
• “How can I compare different outcomes from a number of activities?”
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The Problems Confronting CME
• Funding and resources are decreasing– The core message of the value of CME is not
reaching internal and external stakeholders, policy makers, and society
– There are few resources for professionals to demonstrate the return on CME investment to nonmedical or noneducator audiences
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Solutions
• Demonstrating the benefits of CME depends on effective communication
• Economic data provide a universally understood outcome measure—monetary impact
• Economic modeling of CME is a rapid, cost effective, and repeatable method of predicting cost impact
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Outcomes Impact Analysis
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Outcomes Impact Analysis: A Novel Analytic Framework
• Evaluating the economic impact of CME outcomes is based on the established principles of health economic modeling, decision analysis, probability theory, and statistical analysis
• No single existing economic analysis model is ideally suited for assessing CME outcomes
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• CME symposium was attended by 133 participants
• Reviewed strategies for blood conservation and implementation of the Society of Thoracic Surgeons Blood Conservation Clinical Practice Guidelines
• 93.8% were committed to change their practice based on what they learned
• Major barriers to blood conservation cited were cost, administration buy-in, and inertia
Blood Conservation Symposium: Economic Implications
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• Outcomes impact analysis was used to estimate the potential economic impact of applying CME-related learning to clinical practice for cardiac surgical outcomes:– Prevention of bleeding-related complications– Prevention of reoperation for bleeding in
coronary artery bypass graft (CABG) surgery• Costs averted were estimated from the
perspective of the healthcare provider
Evaluating the Economic Impact
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Bleeding-related complications (BRC)• A study of 103,826 cardiac operations showed that mean
hospital costs were $12,128 higher in patients with a BRC than in those without a BRC; the additive costs from 142,533 thoracic operations was $15,8991
Reoperation for bleeding in CABG• Nineteen studies studies evaluated additive costs of
reoperation for bleeding following CABG (n=755,382); weighted mean was $24,0482-4
Assumptions• Operative volume
– The STS/AATS Workforce Report showed that adult cardiac surgeons (n=1211) performed a mean of 155 cardiac operations and 214 thoracic operations in 20095
Models and Parameters
1. Stokes ME et al. BMC Health Serv Res. 2011;11:135-148.2. Brown PP et al. Ann Thorac Surg. 2008;85:1980-1987.3. Herwaldt LA et al. Infect Control Hosp Epidemiol. 2003;24:44-50.
4. Speir AM et al. Ann Thorac Surg. 2008;85:1980-1987.5. Shemin RJ et al. Ann Thorac Surg. 2012;93:348-355.
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Base Case Analysis• 3 in 10 participants changed clinical
practices as a result of CME learning in such a way as to prevent the outcome of interest (BRC or reoperation)
• Resulted in prevention of BRC and RFB in 2% and 1.5% of operations, respectively
• One year time period
Base Case
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• One-way sensitivity analysis evaluated the potential savings for the base case when the proportion of participants who prevented outcomes of interest varied from 1 in ten to 5 in ten
• Probabilistic sensitivity analysis with second-order Monte Carlo simulation was used to evaluate robustness of the estimate to parameter uncertainty and to calculate a mean and confidence interval for the estimated value
Adjustments• Estimated values were standardized to 2012 $US
using the medical care component of the Consumer Price Index
Sensitivity Analysis
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Results
ModelEstimated Value ($US 2012)
Base Case PSA Mean (95% CI)
Bleeding-related complications, cardiac 1,500,112 1,502,769 (869,860–2,359,068)
Bleeding-related complications, thoracic 2,715,104 2,715,246 (1,590,308-4,217,092)
Reoperation for bleeding, CABG 2,230,873 2,233,988 (1,223,901–3,648,719)
Ravyn D et al. J Cont Educ Health Prof. 2014;34(S1):S41-S46.
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Dynamic Estimator
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Outcomes Impact Analysis
Strengths Limitations
• Rapid, cost effective, and highly versatile
• Can be used in funding decision making or to evaluate outcomes after an activity
• Estimates of the monetary return on education
• Does not require patient-level or medical record data
• Independent of educational modality, audience, or therapy area
• Allows outcomes comparisons across heterogeneous activities
• Data, scenario, assumptions, and time horizon are tailored to the decision maker’s needs
• Results easily understood by nonmedical, noneducator, and lay audiences
• Sensitivity analysis demonstrates results across a wide range of plausible scenarios
• Cost data may be unavailable or unreliable
• Does not provide direct evidence of patient impact; outcomes inferred from utilization
• Serves as an adjunct to, not a replacement of educational outcomes
• Does not usually consider indirect or intangible costs
• Limited to expenditures, does not examine quality of life
• Requires expertise in the therapy area, health services, outcomes, and economic modeling
• As with all economic predictive models, it may be necessary to validate estimated values after implementation
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Conclusions
• Plausible economic estimates suggest that CME-related learning favorably impacting practice yields substantial cost savings
• Model prediction of averted costs associated with CME allows estimation of the economic impact on outcomes in the absence of patient-level outcomes data related to CME activities
• This model may also be used to optimize CME resources by identifying areas of educational need most likely to result in cost savings
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For more information contact Dana [email protected]