IMPACT Project 4 – Budget impact, cost-effectiveness, and population outcomes of interventions to improve clinical communication and health care use in rural and nonrural areas

Interventions aimed at strengthening clinical communication can improve health care use. Yet many healthcare systems struggle to implement such interventions, especially in rural areas where resources are scarce. As part of the P01 Program Project, “Improving Provider Announcement Communication Training (IMPACT),” Projects 1-3 will test novel enhancements of the Announcement Approach Training (AAT) intervention in healthcare systems to improve primary care team members' clinical communication. The overall objective of Project 4 is to facilitate decision makers' selection and adoption of AAT and other effective clinical interventions by quantifying tradeoffs in their comparative cost and health impact in rural and nonrural areas. Aim 1 is to identify differences in contextual factors in rural and nonrural clinical settings that may influence the implementation and effectiveness of enhanced AAT interventions. Using a mixed-methods approach, we will conduct semi-structured interviews in rural (n=20) and nonrural areas (n=20) among primary care team members, quality improvement decision makers, and healthcare administrators, as well as survey a national sample of primary care team members (n=2,500) to examine contextual differences across rural and nonrural clinical settings. Aim 2 is to evaluate the budget impact, cost-effectiveness, and population outcomes of clinical communication and other interventions in rural and nonrural clinical settings, including the enhanced AAT interventions studied in Projects 1-3, to facilitate comparisons for decision making. We will develop a national, county-specific microsimulation model that overlays interventions onto populations to project the anticipated budget impact, cost-effectiveness, and population outcomes of clinical communication interventions in rural and nonrural clinical settings. Aim 3 is to aid stakeholder implementation planning by developing a web-based interactive decision support tool illustrating the value and implementation outcomes of clinical communication interventions in rural and nonrural clinical settings. We will engage stakeholders to evaluate the usability of the decision support tool for decision making and add to the AAT Intervention Package. Project 4 addresses the IMPACT Program Project theme of amplifying clinical communications interventions' impact in healthcare systems. Our findings will translate the health impact and cost of interventions tested in Projects 1-3 in rural and nonrural areas into a dissemination format well-suited to the needs of decision makers in healthcare systems to accelerate the adoption of promising interventions to prevent cancer in various geographic contexts.