PDF(Pubmed)
Abstract：
Communities That HEAL (CTH) is a novel, data-driven community-engaged intervention designed to reduce opioid overdose deaths by increasing community engagement, adoption of an integrated set of evidence-based practices, and delivering a communications campaign across healthcare, behavioral-health, criminal-legal, and other community-based settings. The implementation of such a complex initiative requires up-front investments of time and other expenditures (i.e., start-up costs). Despite the importance of these start-up costs in investment decisions to stakeholders, they are typically excluded from cost-effectiveness analyses. The objective of this study is to report a detailed analysis of CTH start-up costs pre-intervention implementation and to describe the relevance of these data for stakeholders to determine implementation feasibility.
This study is guided by the community perspective, reflecting the investments that a real-world community would need to incur to implement the CTH intervention. We adopted an activity-based costing approach, in which resources related to hiring, training, purchasing, and community dashboard creation were identified through macro- and micro-costing techniques from 34 communities with high rates of fatal opioid overdoses, across four states-Kentucky, Massachusetts, New York, and Ohio. Resources were identified and assigned a unit cost using administrative and semi-structured-interview data. All cost estimates were reported in 2019 dollars.
State-level average and median start-up cost (representing 8-10 communities per state) were $268,657 and $175,683, respectively. Hiring and training represented 40%, equipment and infrastructure costs represented 24%, and dashboard creation represented 36% of the total average start-up cost. Comparatively, hiring and training represented 49%, purchasing costs represented 18%, and dashboard creation represented 34% of the total median start-up cost.
We identified three distinct CTH hiring models that affected start-up costs: hospital-academic (Massachusetts), university-academic (Kentucky and Ohio), and community-leveraged (New York). Hiring, training, and purchasing start-up costs were lowest in New York due to existing local infrastructure. Community-based implementation similar to the New York model may have lower start-up costs due to leveraging of existing infrastructure, relationships, and support from local health departments.
This study is guided by the community perspective, reflecting the investments that a real-world community would need to incur to implement the CTH intervention. We adopted an activity-based costing approach, in which resources related to hiring, training, purchasing, and community dashboard creation were identified through macro- and micro-costing techniques from 34 communities with high rates of fatal opioid overdoses, across four states-Kentucky, Massachusetts, New York, and Ohio. Resources were identified and assigned a unit cost using administrative and semi-structured-interview data. All cost estimates were reported in 2019 dollars.
State-level average and median start-up cost (representing 8-10 communities per state) were $268,657 and $175,683, respectively. Hiring and training represented 40%, equipment and infrastructure costs represented 24%, and dashboard creation represented 36% of the total average start-up cost. Comparatively, hiring and training represented 49%, purchasing costs represented 18%, and dashboard creation represented 34% of the total median start-up cost.
We identified three distinct CTH hiring models that affected start-up costs: hospital-academic (Massachusetts), university-academic (Kentucky and Ohio), and community-leveraged (New York). Hiring, training, and purchasing start-up costs were lowest in New York due to existing local infrastructure. Community-based implementation similar to the New York model may have lower start-up costs due to leveraging of existing infrastructure, relationships, and support from local health departments.
摘要：
背景：治愈的社区（CTH）是一部小说，数据驱动的社区参与干预旨在通过增加社区参与来减少阿片类药物过量死亡，采用一套综合的循证实践，并在整个医疗保健领域开展宣传活动，行为健康，刑事法律,和其他基于社区的设置。实施如此复杂的倡议需要前期投入时间和其他支出(即，启动成本)。尽管这些启动成本在投资决策中对利益相关者的重要性，它们通常被排除在成本效益分析之外。本研究的目的是报告CTH启动成本干预实施前的详细分析，并描述这些数据对利益相关者确定实施可行性的相关性。
方法：本研究以社区视角为指导，反映了现实世界社区实施CTH干预所需的投资。我们采用了基于活动的成本计算方法，其中与招聘相关的资源，培训,采购,通过来自34个致命阿片类药物过量发生率高的社区的宏观和微观成本计算技术，确定了社区仪表板的创建，在四个州——肯塔基州，马萨诸塞州,纽约,俄亥俄州。使用行政和半结构化访谈数据确定了资源并分配了单位成本。所有成本估算均以2019年美元报告。
结果：州级平均和启动成本中位数（代表每个州8-10个社区）分别为268,657美元和175,683美元。招聘和培训占40%，设备和基础设施成本占24%，仪表板创建占总平均启动成本的36%。相对而言,招聘和培训占49%，采购成本占18%，仪表板创建占总启动成本中位数的34%。
结论：我们确定了影响启动成本的三种不同的CTH招聘模式：医院-学术（马萨诸塞州），大学学术（肯塔基州和俄亥俄州），和社区杠杆化(纽约)。招聘,培训,由于现有的当地基础设施，购买启动成本在纽约最低。由于利用现有基础设施，类似于纽约模式的基于社区的实施可能具有较低的启动成本。关系,以及当地卫生部门的支持。
方法：本研究以社区视角为指导，反映了现实世界社区实施CTH干预所需的投资。我们采用了基于活动的成本计算方法，其中与招聘相关的资源，培训,采购,通过来自34个致命阿片类药物过量发生率高的社区的宏观和微观成本计算技术，确定了社区仪表板的创建，在四个州——肯塔基州，马萨诸塞州,纽约,俄亥俄州。使用行政和半结构化访谈数据确定了资源并分配了单位成本。所有成本估算均以2019年美元报告。
结果：州级平均和启动成本中位数（代表每个州8-10个社区）分别为268,657美元和175,683美元。招聘和培训占40%，设备和基础设施成本占24%，仪表板创建占总平均启动成本的36%。相对而言,招聘和培训占49%，采购成本占18%，仪表板创建占总启动成本中位数的34%。
结论：我们确定了影响启动成本的三种不同的CTH招聘模式：医院-学术（马萨诸塞州），大学学术（肯塔基州和俄亥俄州），和社区杠杆化(纽约)。招聘,培训,由于现有的当地基础设施，购买启动成本在纽约最低。由于利用现有基础设施，类似于纽约模式的基于社区的实施可能具有较低的启动成本。关系,以及当地卫生部门的支持。
