title: Process, cost, and clinical quality: the initial oral contraceptive visit.
abstract: To demonstrate how the analysis of clinical process, cost, and outcomes can identify healthcare improvements that reduce cost without sacrificing quality, using the example of the initial visit associated with oral contraceptive pill use.
  
  
  
  Cross-sectional study using data collected by HealthMETRICS between 1996 and 2009.
  
  
  
  Using data collected from 106 sites in 24 states, the unintended pregnancy (UIP) rate, effectiveness of patient education, and unit visit cost were calculated. Staff type providing education and placement of education were recorded. Two-way analysis of variance models were created and tested for significance to identify differences between groups.
  
  
  
  Sites using nonclinical staff to provide education outside the exam were associated with lower cost, higher education scores, and a UIP rate no different from that of sites using clinical staff. Sites also providing patient education during the physical examination were associated with higher cost, lower education scores, and a UIP rate no lower than that of sites providing education outside of the exam.
  
  
  
  Through analyzing process, cost, and quality, lower-cost processes that did not reduce clinical quality were identified. This methodology is applicable to other clinical services for identifying low-cost processes that do not result in lower clinical quality. By using nonclinical staff educators to provide education outside of the physical examination, sites could save an average of 32% of the total cost of the visit.
authors: Signature Healthcare Brockton Hospital/Tufts Medical Center, Boston, MA, USA. mjmcmull2000@yahoo.com
authors: Michael J
authors: MJ
authors: McMullen
authors: Samuel W
authors: SW
authors: Woolford
authors: Charles L
authors: CL
authors: Moore
authors: Barry M
authors: BM
authors: Berger
mesh_terms: D003276:Contraceptives, Oral / Q000191:economics / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D006801:Humans; D009819:Office Visits / Q000191:economics*; D010353:Patient Education as Topic / Q000191:economics / Q000458:organization & administration; D010808:Physical Examination / Q000191:economics / Q000592:standards; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D058996:Quality Improvement / Q000191:economics / Q000458:organization & administration; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration
chemical_list: D003276:Contraceptives, Oral