featured project for the UCLA CTSI Community Engagement and Research Program

1. Estimating the Cost and Cost Savings of
Community Partners in Care
CTSI CERP Monthly Meeting
September 20, 2012
Bowen Chung, James Gilmore, Kenneth Wells,
Elizabeth Dixon, Michael McCreary, Loretta Jones, Michael Ong

2. Background
• Depression is the largest cause of adult disability in the U.S.
• Collaborative Care approaches for depression have been shown to
improve quality, access and outcomes for minorities
• Community Partners in Care is a group level, randomized,
comparative effectiveness trial of 2 approaches for disseminating
and implementing collaborative care for depression in Los Angeles
(PI Wells)
– 1) Resources for Services (RS): low impact technical assistance approach – 1
day training and webinars on different components of collaborative care
– 2) Community Engagement and Planning (CEP): 4 month planning and
network building approach to adapt, train and to implement collaborative
• 2 communities (Hollywood & South Los Angles), 95 programs (46
RS, 49 CEP); providers and administrators (312 enrolled in surveys
or participated in trainings); clients (1018 at baseline and 6
months)

3. Research Question
• To estimate the costs of the CEP and RS interventions
• To estimate the differential impact of RS and CEP on cost of client
services utilization in different service sectors in the study (health,
mental health, substance abuse, social services, and other
community programs).

4. Methods
• Community Partnered Participatory approach
• Monthly workgroup meetings with partners from Healthy African
American Families II, Behavioral Health Services,
• Data Sources
• Survey
– Client survey data, baseline, 6, & 12 month (n=1018)
– Provider and administrator survey data (n=536)
– Provider and administrator training data (n=312)
• Cost
– CMS : DRG codes and payments for inpatient stays
– AMA: CPT codes and payment for medical and mental health
procedures
– National Bureau of Labor Statistics – wages for non-healthcare sector
providers

5. Methods
• Analytic Outcomes – between RS and CEP
– Quality adjusted life year (QALY) based on SF-12
– Days with depression
– Employment, days of work missed due to illness for those employed
– Intervention costs
– Total Healthcare costs (health, mental health, substance abuse)
– Total non-healthcare costs (social services, faith-based, parks, senior
centers)
• Variables
– Independent variable: Intervention status (RS or CEP)
– Baseline disorder status
– Co-variates – age, gender, >=3 chronic conditions, education, race, family
poverty, 12-month alcohol abuse and drug abuse, 12 month depressive
disorder, and community.

6. Outcomes
• Progress to Date
– Collecting and assigning cost data – services utilization, program costs
• Academic outcomes
– Manuscript on cost and cost-effectiveness
• Participatory research outcomes
– Community – academic workgroups
– Community conferences / Knowledge transfer
• Policy related outcomes
– Presentations to local, state, and national policy makers

7. CERP Aims Addressed
• Aim 1 – Promote and sustain bidirectional knowledge sharing
between community and academia
• Aim 2- Strengthen community infrastructure for sustainable
partnered research
• Aim 3 – Drive innovation in community engagement that
accelerates the volume and impact of partnered research in
diverse communities
• Aim 4 – Build health services research methods into
partnerships to accelerate design, production, and wide
adoption of evidence-based practice and behavior

8. Timeline
May June July August September October November December January February
2012 2012 2012 2012 2012 2012 2012 2012 2013 2013
Workgroup
x x x x x x x x x x
Analysis
x x x x x x x x x x
Conference x
Manuscripts x

9. Added-Value from CTSI Funding
• Research Assistant
• Payments for community participants to be active in the
process
• CPIC and partners ability to participate in the CTSI CERP core
and share / learn from other projects

10. Next Steps
• Continue assigning costs and analysis
• In analyses, consider costs from the following perspectives:
societal, healthcare, non-healthcare, community, and client
• Continue to engage the community around data analysis –
especially in areas where costs may not be known or well-
documented, especially outside of healthcare settings
• Also engage community partners to help frame the
presentation for the community conference
• Draft of manuscript by Feb or March 2012