Lessons Learned From Measuring Return on Investment in Public Health Quality Improvement Initiatives.

CONTEXT The Center for Public Health Quality and its partner, North Carolina State University Industrial Extension Service, used 2 existing, yet similar quality improvement (QI) programs to provide technical assistance to conduct return on investment (ROI) and economic impact (EI) analyses so that they could estimate their QI projects' financial impacts. OBJECTIVES The objectives of this article are to describe the approach and ongoing learning from applying ROI and EI analyses to public health QI projects and analyze the results in order to illustrate ROI potential in public health. DESIGN We used a before-after study design for all ROI and EI analyses, spanning a 3-year time period. SETTING The study was conducted as part of 2 existing public health QI training programs that included webinars, face-to-face workshops, on-site facilitation, and longitudinal coaching and mentoring. PARTICIPANTS The QI training programs included multidisciplinary teams from local and state public health programs in North Carolina. MAIN OUTCOME MEASURE Return on investment and EI calculations. RESULTS Numerous adaptations were made over the 3 years of the ROI program to enhance participant's understanding and application. Results show an average EI of $149 000, and a total EI in excess of $5 million for the 35 projects studied. The average ROI per QI project was $8.56 for every $1 invested in the project. CONCLUSIONS Adapting the ROI approach was important in helping teams successfully conduct their ROI analyses. This study suggests that ROI analyses can be effectively applied in public health settings, and the potential for financial return is substantial.