Kari Mader, MD, MPH; Joseph M. Sammen, MPH; Christopher Klene, BA; Jessica Nguyen, MPH; Matthew Simpson, MD, MPH; Sandra L. Ruland, DVM, MS; John M. Westfall, MD, MPH
Acknowledgment: The authors thank Colorado Consumer Health Initiative, 2040 Partners for Health, Cultivando, Clinica Colorado, and Kids First Health Care.
Disclosures: Dr. Mader reports grants and personal fees from the Robert Wood Johnson Foundation during the conduct of the study. Mr. Sammen reports grants from the Robert Wood Johnson Foundation during the conduct of the study. Ms. Nguyen reports grants from the Robert Wood Johnson Foundation during the conduct of the study. Mr. Klene reports grants from Robert Wood Johnson Foundation during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2140.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Financial Support: By the Robert Wood Johnson Foundation Can We Talk? Initiative (project ID 74119).
Corresponding Author: Joseph M. Sammen, MPH, Center for Health Progress, PO Box 18877, Denver, CO 80218; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Mader: University of Colorado–Denver, Academic Office 1, 12631 East 17th Avenue, F496, Room 3119, Aurora, CO 80045.
Mr. Sammen, Mr. Klene, and Ms. Nguyen: Center for Health Progress, PO Box 18877, Denver, CO 80218.
Ms. Ruland, Dr. Simpson, and Dr. Westfall: University of Colorado–Denver, 12631 East 17th Avenue, Aurora, CO 80045.
Author Contributions: Conception and design: J.M. Sammen, J.M. Westfall.
Analysis and interpretation of the data: K. Mader, J.M. Sammen, C. Klene, J. Nguyen, S.L. Ruland, J.M. Westfall.
Drafting of the article: K. Mader, J.M. Sammen, C. Klene, J. Nguyen.
Critical revision of the article for important intellectual content: J.M. Sammen, C. Klene, J. Nguyen, J.M. Westfall.
Final approval of the article: K. Mader, J.M. Sammen, C. Klene, J. Nguyen, M. Simpson, S.L. Ruland, J.M. Westfall.
Statistical expertise: S.L. Ruland.
Obtaining of funding: J.M. Sammen, J.M. Westfall.
Administrative, technical, or logistic support: J.M. Sammen, C. Klene, J. Nguyen.
Collection and assembly of data: K. Mader, J.M. Sammen, C. Klene, J. Nguyen.
Little is known about how to promote cost-of-care conversations in health care settings.
To develop and evaluate community-designed messages promoting cost-of-care conversations.
Focus groups and point-of-care surveys.
Three pediatric clinics, a family community health clinic, and a community health worker (promotora) program serving predominately low-income, Latino populations in Adams County, Colorado.
Focus groups included staff (n = 22) and patients or community members (n = 15). At baseline, 107 patients and 9 providers completed surveys, and 111 patients and 11 providers did so postintervention.
Setting-specific, community-designed messages about cost-of-care conversations delivered to patients on fliers.
Qualitative themes about the frequency and nature of cost-of-care conversations, and frequencies of patient- and provider-reported cost-of-care conversations before and after the intervention.
Five themes emerged from the focus groups, and the groups reported more discussion of costs after distribution of the messaging interventions than before in the clinical but not the community setting. Lack of transparent pricing tools was a barrier, and consideration of incidental costs was important. In cross-sectional, point-of-care surveys, fewer patients reported talking about costs with providers at baseline (44.4%) than after the messaging intervention (73.7%). Providers reported similar frequency of talking about costs with patients before (41.0%) and after (44.9%) the intervention. Nearly one third of patient and provider reports were discordant regarding whether costs were discussed.
The response rate was low, cost-of-care conversations were self-reported, generalizability of the findings to other settings is uncertain, and the sample was small. The survey proved infeasible in the promotora setting.
Participants reported some favorable perceptions of cost-of-care conversations after implementation of community-designed messages, suggesting promise for this approach to promoting conversations about costs of care in settings serving low-income, uninsured Latino populations.
Robert Wood Johnson Foundation.
Evaluation methods used in each health setting.
Table 1. Demographic Characteristics of Card Study Participants at Baseline and Postintervention
Table 2. Patient and Provider Card Study Survey Responses
Table 3. Concordance of Patient- and Provider-Reported Concerns About Ability to Pay and Cost-of-Care Conversations
Table 4. Demographic Characteristics of Focus Group Participants at Baseline and Postintervention
Table 5. Qualitative Analysis Revealing 5 Emergent Themes About Cost-of-Care Conversations Across Clinic and Community Settings
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Mader K, Sammen JM, Klene C, et al. Community-Designed Messaging Interventions to Improve Cost-of-Care Conversations in Settings Serving Low-Income, Latino Populations. Ann Intern Med. 2019;170:S79–S86. doi: 10.7326/M18-2140
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Published: Ann Intern Med. 2019;170(9_Supplement):S79-S86.
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