Evaluating innovation in general practice: a pragmatic framework using programme budgeting and marginal analysis.
BACKGROUND
Innovation in primary care in the UK, in terms of new service developments, is occurring at a fast pace. However, little information is available on the costs and benefits of these changes.


OBJECTIVE
We aimed to illustrate the use of programme budgeting and marginal analysis (PBMA) as a framework for evaluating innovation in primary care, using an example of practice-based diabetes care. The aim was to examine changes in the use of practice resources and the changes in benefits to patients, following the introduction of a diabetes clinic.


METHODS
PBMA is a form of pragmatic economic evaluation combining practice data for the 'before' period and data from the literature to model the 'after' period.


RESULTS
In 1995/6, the total amount of resources devoted to diabetes care in the two practices was 145813 pound sterling (634 pound sterling per patient). Of this sum, 62% was allocated to out-patient visits, 28% to prescribing, 5% to hospital admissions, 2% to GP consultations and 2% to tests. The literature suggests that a nurse-run diabetes clinic would result in similar health outcomes and better access for patients. The introduction of such a clinic could potentially save each practice between 2000 pound sterling and 16000 pound sterling per year. This result takes into account a wide range of assumptions about changes in resource use, but does depend on the findings of previous studies.


CONCLUSIONS
The results of this study show that PBMA is a useful framework for helping practices be accountable and make 'evidence-based' decisions about service innovations in primary care.
Health Economics Research Unit, Department of Public Health, University of Aberdeen, Foresterhill, UK.
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Scott
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Currie
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Donaldson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002017:Budgets; D019090:Case Management / Q000191:economics*; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000191:economics; D005194:Family Practice / Q000191:economics*; D005260:Female; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D009936:Organizational Innovation; D010865:Pilot Projects; D012606:Scotland