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Estimating costs of quality improvement for outpatient healthcare organisations: a practical methodology
  1. Sydney E S Brown,
  2. Marshall H Chin,
  3. Elbert S Huang
  1. Section of General Internal Medicine and the Diabetes Research and Training Center, Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
  1. Correspondence to:
 Dr Elbert S Huang
 University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, Illinois 60637, USA; ehuang{at}


Background: Outpatient healthcare organisations worldwide participate in quality improvement (QI) programmes. Despite the importance of understanding the financial impact of such programmes, there are no established standard methods for empirically assessing QI programme costs and their consequences for small outpatient healthcare organisations.

Objective and methods: The costs and cost consequences were evaluated for a diabetes QI programme implemented throughout the USA in federally qualified community health centres. For five case study centres, survey instruments and methods for data analysis were developed.

Results: Two types of cost/revenue were evaluated. Direct costs/revenues, such as personnel time, items purchased and grants received, were evaluated using self-administered surveys. Cost/revenue consequences, which were cost/revenue changes that may have occurred due to changes in patient utilisation or physician behaviour, were evaluated using electronic billing data. Other methods for evaluating cost/revenue consequences if electronic billing data are not available are also discussed.

Conclusion: This paper describes a practical taxonomy and method for assessing the costs and revenues of QI programmes for outpatient organisations. Results of such analyses will be useful for healthcare organisations implementing QI programmes and also for policy makers designing incentives for QI participation.

  • QI, quality improvement

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  • This study was supported by an Agency for Healthcare Research and Quality (AHRQ) R01 (MC, R01-HS010479), an AHRQ U01 (SB, MC and EH, U01-HS013635), a National Institute on Aging (NIA) Career Development Award (EH, K23-AG021963), a NIDDK Diabetes Research and Training Center (SB, MC and EH, P60 DK20595), the Chicago Center of Excellence in Health Promotion Economics (MC and EH, P30-CD000147), a Robert Wood Johnson Generalist Physician Faculty Scholar Award (MC), and a Midcareer Investigator Award in Patient-Oriented Research from the National Institute of Diabetes and Digestive and Kidney Diseases (MC, K24 DK071933-01).

  • Competing interests: None declared.