The Costs of Implementing a Conversation Aid for Uterine Fibroids in Multiple Health Care Settings

Abstract

Background: Health care organizations considering adopting a conversation aid (CA), a type of patient decision aid innovation, need information about the costs of implementation.

Objectives: The aims of this study were to: (1) calculate the costs of introducing a CA in a study of supported implementation in 5 gynecologic settings that manage individuals diagnosed with uterine fibroids and (2) estimate the potential costs of future clinical implementation efforts in hypothetical settings.

Research design: We used time-driven activity-based costing to estimate the costs of CA implementation at multiple steps: integration with an electronic health record, preimplementation, implementation, and sustainability. We then estimated costs for 2 disparate hypothetical implementation scenarios.

Subjects and data collection: We conducted semistructured interviews with participants and examined internal documentation.

Results: We interviewed 41 individuals, analyzed 51 documents and 100 emails. Overall total implementation costs over ∼36 months of activities varied significantly across the 5 settings, ranging from $14,157 to $69,134. Factors influencing costs included size/complexity of the setting, urban/rural location, practice culture, and capacity to automate patient identification. Initial investments were substantial, comprising mostly personnel time. Settings that embedded CA use into standard workflows and automated identification of appropriate patients had the lowest initial investment and sustainability costs. Our estimates of the costs of sustaining implementation were much lower than initial investments and mostly attributable to CA subscription fees.

Conclusion: Initiation and implementation of the interventions require significant personnel effort. Ongoing costs to maintain use are much lower and are a small fraction of overall organizational operating costs.

FIGURE 1

Model of the implementation process. Depicts the major phases of implementation and activities required in each phase. Time estimates are projections of how long each step may take in an independent implementation. Duration of project phases were artificially inflated due to the COVID-19 pandemic. EHR indicates electronic health record.

FIGURE 2

Length of phases, personnel hours, and costs by phase and site. The length of time each setting spent in each phase (top), number of hours spent by personnel in each phase (middle), and the total cost of each phase (bottom). All are highly variable across settings. *General care; **Specialty care. EHR indicates electronic health record; MW, midwest; NE, northeast.