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2019 HSR&D/QUERI National Conference Abstract

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1175 — A Mixed Methods Approach to Quantifying the Implementation Costs of a Major Healthcare Redesign Effort: The VHA Whole Health Flagship Experience

Lead/Presenter: Steven Zeliadt,  COIN - Seattle/Denver
All Authors: Zeliadt S (Veterans Administration (VA) HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA), Hyde J (VA HSR&D Center for Healthcare Organization and Implementation Research (CHOIR), , Bedford, MA) Tomlanovich N (VA HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA) Bolton R (Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA) Dryden E (Institute for Community Health, Malden, MA) Dvorin K (VA HSR&D CHOIR, Bedford, MA) Wu J (VA HSR&D CHOIR, Bedford, MA) Bokhour B (VA HSR&D CHOIR, Bedford, MA)

Objectives:
The Veterans Health Administration (VHA) has targeted 18 sites to implement a redesigned system of care called Whole Health based on providing personalized, proactive, patient-driven care using traditional clinical care with broader use of personalized health planning and complementary and integrative health (CIH). One aspect of the evaluation is to identify personnel costs associated with implementation activities. In this study we test a modified survey approach to measuring implementation costs. Established methods for assessing these costs are impractical. We report the variation in implementation costs and the sources of variation in this implementation of a major redesign of healthcare across multiple facilities.

Methods:
A mixed methods approach was used including repeated surveys (n = 6) followed by qualitative interviews with site leaders that provided an opportunity to learn more about the reported implementation activities. Survey items identified core staff associated with implementation efforts and their estimated time dedicated to implementation activities. All personnel hours were converted to wages based on VHA salary levels.

Results:
We identified 213 key clinical, educational, and administrative personnel involved in the implementation of the Whole Health System of Care at the 18 sites. All sites were guided to fund 7 core positions directed towards implementation in FY18, the first year of implementation. The actual number varied, ranging from 0 to 9. Personnel hours ranged from 2,078 to 19,740 and total wages ranged from $153,284 to $1,107,819. During year 1, core staff focused primarily on infrastructure building activities. Staffing costs were not consistent over the year, with total hours and personnel costs increasing as sites hired appropriate leaders. Generally, sites with greater cost expenditures were further along in their stage of implementation than others.

Implications:
The mixed methods approach used in this implementation study is a relatively low burden, high yield approach to gathering implementation cost data. Moreover, the combination of approaches allows for implementation teams to understand the costs and reasons for variability across sites. However, training and feedback is required to ensure implementation activities logged are consistent across multiple respondents.

Impacts:
Assessing implementation costs alongside the evaluation of implementation efforts can provide critical information about resources necessary to implement complex clinical programs.