title: Continuous quality improvement in substance abuse treatment facilities: How much does it cost?
abstract: Continuous quality improvement (CQI) has grown in the U.S. since the 1970s, yet little is known about the costs to implement CQI in substance abuse treatment facilities. This paper is part of a larger group randomized control trial in a large urban county evaluating the impact of Plan-Study-Do-Act (PDSA)-CQI designed for community service organizations (Hunter, Ober, Paddock, Hunt, & Levan, 2014). Operated by one umbrella organization, each of the eight facilities of the study, four residential and four outpatient substance abuse treatment facilities, selected their own CQI Actions, including administrative- and clinical care-related Actions. Using an activity-based costing approach, we collected labor and supplies and equipment costs directly attributable to CQI Actions over a 12-month trial period. Our study finds implementation of CQI and meeting costs of this trial per facility were approximately $2000 to $10,500 per year ($4500 on average), or $10 to $60 per admitted client. We provide a description of the sources of variation in these costs, including differing intensity of the CQI Actions selected, which should help decision makers plan use of PDSA-CQI.
authors.affiliation: RAND Corporation, Santa Monica, CA, USA; Institute for the Study of Labor (IZA), Bonn, Germany. Electronic address: phunt@rand.org.
authors.forename: Priscillia
authors.initials: P
authors.lastname: Hunt
authors.affiliation: RAND Corporation, Santa Monica, CA, USA.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Hunter
authors.affiliation: Behavioral Health Services, Los Angeles, CA, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Levan
mesh_terms: D003153:Community Health Services / Q000191:economics / Q000592:standards; D017048:Health Care Costs; D006801:Humans; D010865:Pilot Projects; D058996:Quality Improvement; D016320:Substance Abuse Treatment Centers / Q000191:economics / Q000592:standards*; D019966:Substance-Related Disorders / Q000191:economics / Q000628:therapy*; D014481:United States; D019037:Urban Health Services / Q000191:economics / Q000592:standards
keywords: Continuous quality improvement; Group randomized controlled pilot trial; Health care costs; Time spent