title: Measuring the Cost and Value of Quality Improvement Initiatives for Local Health Departments.
abstract: To demonstrate an approach to measuring the cost and value of quality improvement (QI) implementation in local health departments (LHDs).
  
  
  
  We conducted cost estimation for 4 LHD QI projects and return-on-investment (ROI) analysis for 2 selected LHD QI projects.
  
  
  
  Four Nebraska LHDs varying in rurality and jurisdiction size.
  
  
  
  Total costs, unit costs, incremental cost-effectiveness ratios, and ROI.
  
  
  
  The 4 QI projects vary significantly in their cost estimates. Estimated ROI ratios for 2 QI projects predicted significant savings in health care utilization for respective program participants. A QI project focused on improving breastfeeding rates in WIC (women, infants, and children) clients had a predicted ROI ratio of 3230% and a QI project for improving participation in a Chronic Disease Self-Management Program would need only 34 new participants to have a positive ROI.
  
  
  
  We demonstrated how data can be collected and analyzed for cost estimation and ROI analysis to quantify the economic value of QI for LHDs. Our ROI analysis shows that QI initiatives have great potential to enhance the value of LHDs' public health services. A better understanding of the costs and value of QI will enable LHDs to appropriately allocate and utilize their limited resources for suitable QI initiatives.
authors.affiliation: Department of Health Services Research and Administration and Nebraska Public Health Practice-Based Research Network, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska (Drs Chen and Palm); and Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska (Drs Wilson and Mss Gregg, Gupta, and Bekmuratova).
authors.forename: Li-Wu
authors.initials: LW
authors.lastname: Chen
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Wilson
authors.forename: Abbey
authors.initials: A
authors.lastname: Gregg
authors.forename: Niodita
authors.initials: N
authors.lastname: Gupta
authors.forename: Sarbinaz
authors.initials: S
authors.lastname: Bekmuratova
authors.forename: David
authors.initials: D
authors.lastname: Palm
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D009111:Local Government; D009329:Nebraska; D011634:Public Health / Q000191:economics* / Q000592:standards* / Q000639:trends; D058996:Quality Improvement / Q000145:classification* / Q000191:economics* / Q000639:trends