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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Knowledge is Power: CME Reduces HIV Healthcare Costs

February 21st, 2016

By Gary Evans, Senior Staff Writer

At a time of fiscal pressure on healthcare budgets, researchers are finding potentially dramatic cost reductions, not to mention improved medical outcomes, through continuing medical education (CME).

In a study1 that estimated the economic impact of CME activities designed to enhance clinical knowledge of testing and treating HIV patients, researchers report some $10.7 million saved annually when testing-related awareness led to decreased HIV transmission. In addition, earlier initiation of antiretroviral therapy (ART) prevented some $11.6 million in healthcare costs.

As CD4 white cell counts decline with the progression of HIV/AIDS, treatment becomes more problematic and expensive. Thus the costs averted through early intervention of ART rose to a staggering $39.5 million when comparing initiating treatment at 351-500 CD4 cells/ μL versus < 200 CD4 cells/μL. The aforementioned $11.6 million saved was based on ART initiation at 351-500 CD4 cells/μL versus 201-350 CD4 cells/μL.

Published in CME Measure, the study was a collaboration between HealthHIV, CMEology and other partners.

While one can intuitively posit that educating providers on best practices and timely interventions would lead to better patient outcomes and reduced costs, there actually have been relatively few studies assessing the fiscal impact and cost effectiveness of CME.

“Studies on the economic impact of continuing medical education are few and far between, yet results from the analysis reported in this issue suggest tremendous potential,” said Derek Dietze, MA, FACEHP, CHCP, editor in chief of CE Measure.

Citing Centers for Disease Control and Prevention estimates, the authors noted that about 16% of HIV-positive people in the U.S. are unaware they are infected. Testing can result in prevention of subsequent transmission to others while linking the infected patient to care and initiation of ART. The CDC estimates that once diagnosed 65.8% of HIV patients are linked to care, 36.7% are retained in care, 32.7% receive ART, and 25.3% achieve virologic suppression.

Delayed diagnosis, on the other hand, often occurs too late to fully benefit from ART. For example, among those diagnosed with HIV in 2012, 24% had advanced to full-blown AIDS. Citing previous studies showing that educating healthcare professionals leads to increased screening and testing for HIV, the authors designed an educational intervention to enhance competence in testing, linkage to care, and treatment of HIV patients. The activity audience was primary care physicians, physician assistants, nurse practitioners, and nurses involved in the management of HIV patients.

The researchers used a series of live and online CME activities designed to enhance knowledge and competence in testing and treating HIV in the primary care setting. A mathematical model was used to estimate decreased transmission of HIV resulting from awareness of infection and earlier initiation of antiretroviral therapy. Competence was measured using pre- and post-activity case vignettes. Costs averted when participants implemented learning into their clinical practices were estimated using an outcomes impact analysis (OIA) model. Participants from the live (n = 64) and online (n = 230) activities demonstrated educationally and statistically significant improvement in all competencies. Evaluations demonstrated a strong commitment to change and the intention to incorporate learning into practice

“The economic impact of CME can demonstrate its value to stakeholders, healthcare payers, and society,” the authors concluded. “Educating physicians and nurses about the importance of diagnosing and treating HIV not only has an impact as a public health measure, it can be associated with decreased healthcare cost burden.”

Reference

1. Ravyn D, Kummerle D, Hujdich B, et al. Educational and Economic Outcomes of an Intervention to Improve Early Testing and Treatment of HIV. CE Meas 2015;9:20-25.