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Reducing the Costs of an Eye Care Adherence Program for Underserved Children Referred Through Inner-City Vision
Seung Ah Chung1, Melanie Snitzer2, Katherine M Prioli3
1From the Pediatric Ophthalmology and Ocular Genetics (S.A.C., M.S.) and the Biostatistics Consulting Core, Vicky and Jack Farber Vision Research Center (Q.Z.), Wills Eye Hospital, Philadelphia, Pennsylvania, USA; Center for Health Outcomes, Policy, and Economics, Rutgers University, Piscataway, New Jersey, USA (K.M.P., L.T.P.).
Insights
The revised Children's Eye Care Adherence Program (CECAP2) significantly reduced costs by over 50% compared to CECAP1. This improved intervention maintained effectiveness in ensuring children receive necessary follow-up eye care.
Area of Science:
- Public Health
- Ophthalmology
- Health Services Research
Background:
- Underserved children often face barriers to consistent eye care adherence.
- The initial Children's Eye Care Adherence Program (CECAP1) demonstrated a need for intervention but incurred significant costs.
- Cost-effectiveness is crucial for sustainable public health programs.
Purpose of the Study:
- To evaluate the costs and effectiveness of a revised Children's Eye Care Adherence Program (CECAP2).
- To determine if programmatic modifications could reduce intervention costs without compromising patient outcomes.
- To optimize resource allocation for pediatric eye care adherence programs.
Main Methods:
- A retrospective cohort study analyzed records of children referred to CECAP2.
- Intervention modifications included prioritizing high-likelihood patients, reducing contact attempts, and narrowing the geographic area.
- Cost was determined by social worker time; effectiveness was measured by follow-up visit completion rates.
Main Results:
- CECAP2 achieved a 52.4% completion rate for recommended eye examinations, similar to CECAP1's 52.3%.
- Social worker time per patient decreased from 2.6 hours to 0.8 hours (P < .01).
- Cost per patient was reduced to $32.73 from $77.20 (P < .01).
Conclusions:
- Programmatic revisions successfully reduced intervention costs by over 50%.
- The optimized CECAP2 maintained its effectiveness in improving pediatric eye care adherence.
- Targeted strategies and streamlined processes enhance the efficiency of social worker-led adherence programs.
Purpose:
We previously reported costs and outcomes of the Children's Eye Care Adherence Program (CECAP1), a social worker intervention designed to improve adherence to eye care for underserved children in urban Philadelphia. Using cost findings from CECAP1, we revised the intervention to reduce costs. The aim of this study was to evaluate costs and effectiveness of the revised intervention (CECAP2).
Design:
Retrospective cohort study.
Methods:
Records of children needing ophthalmic follow-up after 2 community-based vision screening programs were reviewed. We modified CECAP1 to prioritize children more likely to visit, decreased phone calls and scheduling attempts, better documented children already followed by other doctors, and constricted our geographic catchment area for better accessibility. Cost was calculated using time spent executing CECAP2 by our salaried social worker. Effectiveness was defined as the percentage of patients completing at least 1 follow-up visit within the recommended time frame.
Results:
Of 462 children referred to CECAP2 from our in-school and on-campus screening programs, 242 (52.4%) completed subsequent recommended eye examinations, a proportion identical to our prior report (52.3%). Social worker time per patient was 0.8 hours; a significant reduction from the previous 2.6 hours (P < .01). Cost per patient was $32.73; a significant reduction compared to the previous $77.20 (P < .01).
Conclusions:
Programmatic changes to reduce social worker intervention time and target potential patients by likelihood to attend along with constriction of the catchment area led to reduced costs by more than 50%, without impairing CECAP effectiveness.
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