Forging a Poison Prevention and Control System (2004) / Chapter Skim
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6 Current Costs, Funding, and Organizational Structures
6 Current Costs, Funding, and Organizational Structures
Pages 136-175
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From page 136... ...
The methods included six in-depth case studies examining the time and costs associated with poison control center activities and a written survey mailed to all 75 centers that posed a series of general questions regarding size, location, activities, and organizational affiliations. The results showed that the majority of staff time and expense, regardless of center size or penetrance, was associated with providing telephone advice to the public and health care professionals.
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From page 137... ...
These centers were a stratified, nonprobability sample based on cost per human exposure call handled in 2001, population served, and penetrance. COST-EFFECTIVENESS AND COST-BENEFIT ANALYSES While poison control centers perform a number of activities (see Chapter 5)
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From page 138... ...
Indeed, the literature supports the proposition that for every dollar spent on treatment management activities, multiple dollars are saved by the health care system as a whole. These studies do not examine the costeffectiveness among poison control centers, but rather compare the centers with other health care providers such as emergency departments.
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From page 139... ...
(1998) used the results of another "natural experiment" to examine cost savings of poison control centers.
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From page 140... ...
The authors concluded that for cold preparation overdoses, and under the assumptions of their model, poison control centers lead to lower costs to the health care system and better outcomes in terms of morbidity and mortality. The cost savings result both from the centers triaging visits to the emergency departments and from the cost savings associated with better health outcomes for those cases going to the emergency departments that have already gone through the centers.
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From page 141... ...
All of the above analyses focus on tangible cost savings associated with poison control centers. In such analyses, intangible psychological benefits to the public of such centers are not considered.
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From page 142... ...
Preliminary Characterization This section provides a description of the population of poison control centers in terms of their staffing, population served, revenue sources, and other operating characteristics. In 2001 (American Association of Poison Control Centers, 2002b)
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From page 143... ...
As can be seen from the figure, the size ranges from 634,000 to nearly 35 million. Because the largest poison control center is California's, which operates as a four-region poison control system, average population size served by centers may be highly skewed; therefore, the median population served of 3.8 million is probably a better indicator of the average for all poison control centers.
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From page 144... ...
144 FORGING A POISON PREVENTION AND CONTROL SYSTEM TABLE 6-1 General Characteristics of Poison Control Centers Standard N Median Mean Deviation Minimum Maximum Population Served 62 3,765,293 4,593,562 4,492,049 634,448 34,501,130 Calls: Human poison exposure calls 62 31,514 37,155 31,125 3,150 230,438 Information calls 62 11,928 16,569 13,066 1,491 62,003 Animal poison exposure calls 62 1,043 1,850 2,380 0 12,118 Nonexposure calls 62 89 117.7 97.23 0 450.0 All calls 62 47,272 55,687 41,767 4,716 300,321 Human exposure calls: % total calls 62 68.5% 66% 11.2% 37.7% 88.% Penetrance: Human exposure calls per 1,000 population 62 8.291 8.611 2.502 4.946 16.79 Staffing: Managing director full-time equivalents (FTEs) 61 1.00 0.971 0.455 0 3.500 FTEs of medical director funded 62 .50 0.667 0.498 0 3.150 FTEs of medical director 62 .60 0.751 0.559 0.0125 3.500 FTEs: Administrative staff 62 2.00 2.100 1.976 0 10.73 Health educator FTEs 62 1.00 1.151 1.048 0 7.500 Total PIP and CSPI/ SPI FTEs 62 9.85 10.94 7.511 0 55.90 Total PIP FTEs 62 0 1.060 2.366 0 14.50 Total CSPI plus SPI FTEs 62 9.30 9.877 5.915 0 41.40 FTEs: SPI plus CSPI : % total FTE 61 100.0% 91.8% 15.5% 33.3% 100.0% Expenses: Total expenses 61 1.2E6 1.38E6 968,595 116,579 6.89E6 Personnel expenses 61 1.0E6 1.1E6 775,509 101,579 5.7E6 All nonpersonnel expenses 61 181,071 276.431 254,894 15,000 1.05E6 Expenses per 1,000 population 61 303.2 336.8 131.9 82.76 723.8
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From page 145... ...
, the managing director was also the medical director. Two poison control centers had no managing director and four had no medical director.
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From page 147... ...
. Because of the lack of regular funding sources, poison control centers report that significant time is spent raising revenues and that there has been substantial instability in funding.
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From page 148... ...
5,512,808 5.27% 20 Host institution: Host hospital 10,841,344 10.37% 38 Other host institution 378,696 0.36% 3 Total host institution 11,220,040 10.73% 42 Donations/grants: Children's Miracle Network 225,528 0.22% 5 Community service organizations 70,225 0.07% 4 Corporations 486,064 0.46% 13 Events 23,815 0.02% 1
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From page 149... ...
Taken as a whole, AAPCC data indicate that poison control centers display wide variability in virtually all aspects of staffing, operations, and costs. The population of centers can therefore best be characterized as highly heterogeneous, with few common structural or operational characteristics to form the basis for characterizing a "typical" center.
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From page 152... ...
(1997) conducted a detailed examination of the activities of six poison control centers and allocated all activity costs among eight functions: treatment management guidance, public prevention and promotion, professional education, protocol assessment and poison surveillance and data collection, interaction with local and regional public health and safety officials, and research.
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From page 153... ...
Moreover, even if there are economies of scale in handling calls from the public, this is only one of the core functions of a poison control center, and the question of the optimal size of a center must consider these other functions as well. Explanatory Models of Poison Control Center Costs In an attempt to explain the wide variation in costs incurred by poison control centers, expenses per human exposure call (a call fielded about a person who may or may not have been poisoned)
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From page 154... ...
Total expenses per human exposure call was negatively associated with a larger population served. Factors positively associated with this dependent variable were location in the Northeast region, 24-hour coverage by SPIs, and more health educator FTEs.
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From page 155... ...
This means that a substantial portion of cost differentials across centers is not accounted for by variables in the models and that other unmeasured factors may be contributing to such differentials. Qualitative Analysis of Organizational Characteristics Sample Selection The analysis of the 2001 AAPCC survey data shows significant variability among poison control centers on a number of dimensions, including total costs, personnel costs, and nonpersonnel costs per (1)
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From page 156... ...
To describe and compare the organizational characteristics of poison control centers in depth, a stratified nonprobability sample of 10 centers was selected for further qualitative study based on semistructured interviews with key informants at each site. The two principal strata of selection were based on cost per human exposure call handled in 2001 and total population served combined with total human exposure calls per population per 1,000 (penetrance)
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From page 157... ...
TABLE 6-4 Differences Between Low-Efficiency and High-Efficiency Centers Survey Variables High Efficiency Low Efficiency Affiliation Most are private not-for- Most are public not-for profit profit Staffing Slightly lower staff turnover Slightly higher staff rate turnover rate Less likely to mention low More likely to mention low pay as a contributor to pay as a contributor to staff turnover staff turnover More staff hours spent Fewer staff hours spent weekly on all poison weekly on all poison control center activities; control center activities; more staff hours spent on fewer staff hours spent on poison prevention poison prevention other than direct client response Services and activities · Current practices More full-time equivalents Fewer FTEs devoted to (FTEs) devoted to education and outreach education and outreach · Areas of growth No differences No differences · Areas of decline Industry contracts, general Professional education, call volume, resident fellowship training, training general call volume Interorganizational More likely to have Less likely to have relationships partnership or joint partnership or joint venture arrangement with venture arrangement with another organization another organization Less shared staff and shared More shared staff and information technology shared IT (IT)
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From page 158... ...
158 FORGING A POISON PREVENTION AND CONTROL SYSTEM TABLE 6-4 Continued Survey Variables High Efficiency Low Efficiency Quality improvement No differences No differences and assurance Research and training No differences No differences Future organizational More likely to have a Less likely to have a challenges strategic plan specific to strategic plan specific to poison control center poison control center Less likely to cite problems More likely to cite problems related to complex related to complex reporting and reporting and accountability accountability Less likely to cite balancing More likely to cite balancing core poison control core poison control functions with other functions with other activities such as research activities such as research and bioterrorism response and bioterrorism response and preparedness and preparedness TABLE 6-5 Differences Between Centers Serving Large and Small Populations Survey Variables Large Population Small Population Affiliation No differences No differences Staffing More likely to use paid Less likely to use paid consultants other than consultants other than medical director medical director Less likely to cite low pay as More likely to cite low pay reason for turnover as reason for turnover Employ more full-time Employ fewer FTEs equivalents (FTEs) Fewer hours spent on all More hours spent on all poison control center poison control center activities and nonclient activities and nonclient response activity response activity Services and activities · Current practices More extensive involvement Less extensive involvement in professional education, in professional education, public education, and public education, and outreach outreach
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From page 159... ...
The organizational structure of most of the centers surveyed is relatively flat, with a managing director and medical director comprising the senior staff, with poison information personnel and educators reporting directly to them. Two centers have additional midlevel personnel, such as associate directors or education or administrative coordinators.
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From page 160... ...
Five centers have lower costs per human exposure call (i.e., below the mean cost for all poison control centers) , while the remaining five have higher costs (above the mean)
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From page 161... ...
Centers serving smaller populations estimate lower numbers of hours spent weekly on all poison control center activities (370 to 490 versus 670 to 1,095 hours) , as well as lower numbers of weekly hours spent on poison prevention and control activities other than direct client response (60 to 120 versus 100 to 500 hours)
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From page 162... ...
Lower-cost centers, however, are much less likely to mention low pay as contributing to turnover rates. With one exception, higher-cost centers estimate fewer hours spent weekly on all poison control center activities (370 to 690 versus 670 to 1,000 hours)
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From page 163... ...
With one exception, research FTEs are no more limited at centers serving smaller populations than they are in centers serving larger populations. Low-population center research FTEs range from minimal to 1.75; for high-population centers this ranges from 0.1 to 1.25 (with one outlier site having 6 research FTEs, predominantly fellows)
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From page 164... ...
More centers serving larger populations reported growth in professional education (three centers) , and growth in public education and outreach (five centers)
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From page 165... ...
Centers serving larger populations, while also experiencing declines due to funding issues, also reported declines in service due to other factors -- two of these centers reported declines in exposure calls as a percentage of all calls, while three others reported declines in overall call volume. Also mentioned were decreases in industry contracts, professional or resident training, and other types of calls (animal exposures, drug decoding, pesticide calls)
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From page 166... ...
Two centers share information technology, some staff, and call volume with other poison control centers in their state. Two other centers share only databases for joint research projects, and three others mention providing occasional coverage for another center or handing off patients to a nearby center.
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From page 167... ...
In most instances, these reviews are done by senior personnel, and in particular the medical director; however, a few centers also involve other staff in quality reviews, including specialists in poison information, as a part of their ongoing training. Two centers have mission and vision statements related to quality improvement.
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From page 168... ...
Two centers do not have a strategic plan of their own, but have written objectives or a mission and vision statement specific to the center. The most often mentioned organizational challenge the poison control centers face is staff recruitment and retention, particularly for SPIs.
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From page 169... ...
Some respondents express the opinion that poison control centers have been overlooked and should be more involved in these "noncore" issues. However, they also recognize the difficulties of coordinating multiple missions, given the realities of multiple, separate funding streams and already fragmented organizational structures.
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From page 170... ...
human exposure calls. There is little conclusive evidence that economies of scale operate with respect to size of population served and poison control center costs, particularly for centers serving populations of 2 million or more.
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From page 171... ...
Both types of centers, however, mentioned declines in call volumes. The most often-mentioned organizational challenge the poison control centers face is staff recruitment and retention, particularly for SPIs.
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From page 172... ...
During a typical week, what is the total number of hours that your staff, including consultants, independent contractors, and administrative staff, work at all activities for your poison control center? What is the total number of hours per week spent by these staff members conducting services other than direct client response, but relating to poison control and prevention?
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From page 173... ...
What types of services does your poison control center provide to other provider organizations: data analysis, education, consulting, client referrals, other? Does your poison control center share any services with another poison control center or organization: administrative support services (clerical)
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From page 174... ...
Is there funding specifically for poison control center research and is it sufficient? Is there funding specifically for staff training and toxicology fellowship training and is it sufficient?
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From page 175... ...
CURRENT COSTS, FUNDING, AND ORGANIZATIONAL STRUCTURES 175 FUTURE Does your poison control center have a formal written strategic plan, or is the center a part of a larger unit/organization with such a strategic plan? Other than sustainable funding, what are the most pressing organizational challenges faced by your center currently?
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