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Budget Cuts in a Shelby County Clinic: A Case Study

Rebecca manages a Shelby County clinic in Memphis, Tennessee. The clinic serves the local Medicaid population. The clinic’s budget was cut by 15%. Rebecca must determine what clinical services can be eliminated or introduced to best address the healthcare needs of the patients. In order to make the best decision for the clinic and the patients, Rebecca will use the Informed Decisions Toolbox (IDT) (Arroyo et al, 2007). Following is a case study of Rebecca’s decision making process. The IDT will be defined and Rebecca will follow the steps to make an informed decision. Her decision to focus the clinic’s efforts on early intervention, preventive medicine, STD/HIV prevention, and case management will be explained. Why the Four A’s tool is determined to be the most effective in making the decision will be addressed (Arroyo et al, 2007). Finally, the use of the toolbox and the affect on the clinic’s accountability, knowledge transfer, and becoming a questioning organization will be studied.
The Informed Decisions Toolbox (IDT)
The Informed Decisions Toolbox (IDT) is a set of tools that can be useful to healthcare managers when making decisions. The toolbox consists of six steps that can lead to a well-informed decision:
Step 1: Framing the question
Step 2: Finding sources of information
Step 3: Assessing the accuracy of the evidence
Step 4: Assessing the applicability of the evidence
Step 5: Assessing the "actionability" of the evidence
Step 6: Determining if the information is adequate
(Arroyo et al, 2007)
Step 1: Framing the Question
First, Rebecca must formulate a question. “A well-defined question will explicitly state the intervention, the outcome of interest, the type of setting, the time frame, and the population” (Arroyo et al, 2007, para. 12). The intervention is the 15% budget cut and the outcome of interest is to add or reduce services to better serve the patients. The setting is a Shelby County clinic, and the population served is the Medicaid population of Memphis, Tennessee. The Medicaid population includes low-income individuals who meet one of the following criteria: Are pregnant, under the age of 19, are 65 years of age or older, and who are blind, disabled or need nursing home care ("Centers For Medicare & Medicaid Services", n.d.). The time frame would be from 2011 forward. Rebecca formulated the following question:
Following the 15% cut in our clinic’s budget, what services must be cut and/or added in order to best serve the Medicaid population in Shelby County in 2011 and beyond?
Rebecca must now search for information that will assist in making a well-informed decision.
Step Two: Finding Sources of Information Sources of information can range from internet sites, journals, books, newspapers and colloquial sources, such as the past experiences of Rebecca’s colleagues. Rebecca determined that colloquial sources are untrustworthy because her colleagues’ experiences are from different areas of the country and other organizations (Arroyo et al, 2007). This decision must focus on Shelby County’s Medicaid population and its unique needs. Moreover, the decision must take into account new healthcare laws. A prominent new healthcare law is the Affordable Care Act. Rebecca notes that one of the key aspects of the law is that many preventive care services will no longer require cost sharing for insured patients. Eliminating the cost barrier will encourage the use of preventive services and reduce overall health care costs (Cogan, J. 2011). Free services range from routine blood work and immunizations, counseling, to well child visits. According to "Background: The Affordable Care Acts New Rules on Preventive Care" (n.d.), eliminating cost-sharing for preventive care, will make it easier and more affordable for Medicaid patients to obtain important preventive services (para. 5). Rebecca finds that in 2008, Memphis ranked first among the nation’s top 50 largest metropolitan areas for rates of Chlamydia, Gonorrhea, and Syphilis. Persons aged 15-19 have the highest Chlamydia and Gonorrhea rates in the county ("Shelby County Health Department", n.d.). Moreover, the Department of Health and Human Services conducted a survey of Memphis youth risk behavior among high school students in 2007 and found that 63% had had sexual intercourse, and 26% did not use a condom during their most recent sexual intercourse ("The Hiv Epidemic And Memphis Students", n.d.).
The rate of HIV infection is twice the national average and Shelby County is home to 40% of Tennessee’s HIV population (Maki, 2010). The Ryan White CARE Act was enacted to provide higher quality HIV/AIDS treatment to underserved populations. It provides funding to states and other organizations so that more cost-effective and efficient care can be provided to individuals with HIV/AIDS ("Aids In Action", n.a.). Part C of the bill focuses on early intervention and provides grants for use in providing services such as HIV testing, counseling, and case management ("Aids In Action", n.a.).
Rebecca finds that case managers can assist the patient while they are at the clinic, set-up appointments with specialists, create follow-up plans/goals, and keep track of the patient’s progress. The case manager can reduce overall health care costs for the clinic by encouraging preventive care and reducing re-admissions. In addition, the case manager can evaluate staffing and training needs at the clinic (“Move to accountable care puts case managers in the spotlight,” 2011).
After much research and data collection, Rebecca must now determine the accuracy, applicability, actionability, and adequacy of the evidence. This is referred to as the Four A’s of useful evidence (Arroyo et al, 2007).
Step 3: Assessing the Accuracy of the Evidence * Establishes causal relationship: “not expert opinion” * Provides a complete, balanced viewpoint: “good, bad, and ugly” * Provides information on relevant statistical properties without necessarily eliminating data based on arbitrary standards of precision. * Provides information on limitations * Credible source: unbiased support (funding) and implementation * Transparent process: how data are collected and how findings follow the data * Based on observational studies and tacit information * Robust * Empirical * Valid
(Arroyo et al, 2007)
Step 4: Assessing the Applicability of the Evidence * Research is relevant to the decision maker’s question * Research states in which situations it is applicable * Information is applicable to the decision maker’s organization and environment
(Arroyo et al, 2007)
Step 5: Assessing the “Actionability” of the Evidence * Fits into the time frame of original decision * Information on what needs to be done * Provides information on a complete set of implications, including costs, overall importance, and values * Identifies best practices * Measurable quality indicators * Portrays expected vs. actual outcomes * Should evaluate usefulness of technology * Considers context, including other available information (e.g., includes tacit information)
* Easy to obtain: at our fingertips * Presentation framing consistent with decision maker’s needs
(Arroyo et al, 2007)
Step 6: Determining if the Information is Adequate * What are your decision options? * Rebecca determines that her decision options are as follows:
1: Make clinic’s focus on early intervention/preventive medicine.
2: Offer more comprehensive HIV/AIDS testing and counseling services.
3: Focus on STD prevention in age 15-19 group.
4: Hire case manager(s) to assist in early intervention focus, cost reduction and staffing needs. * Do I have a complete list of options? * The list of options is complete and focused on what can be done immediately to reduce costs at the clinic. * What does the available credible evidence indicate about each of your decision options? * The available credible evidence indicates that each option would assist in reducing overall costs and best serve the needs of the client base. * Is there a dominant option? More than one option involving trade-offs? Inadequate information? * The dominant option is the focus on preventive care to reduce costs. The case management option possibly involves the trade-off of staff reduction.
(Arroyo et al, 2007)
Most Important Tool: The Four A’s
Rebecca found the Four A’s to be the most important tool. The questions helped Rebecca to evaluate the evidence. It helped take her personal opinion out of the equation because it focuses on organizational goals rather than personal agendas. The Four A’s ensure that a well-informed organizational decision is made (Arroyo et al, 2007).
The Use of the Toolbox and its Affect on Accountability, Knowledge Transfer, and the Clinic as a Questioning Organization
Healthcare organizations and decision makers are held accountable for their actions and are increasingly put under the microscope due to healthcare reform. Decision makers must prove that decisions made are based on sound research (Arroyo et al, 2007). The toolbox aids in making organized, well-informed decisions. Knowledge transfer is typically handled by a knowledge manager. Their job is to “identify, create, represent, and distribute knowledge for reuse, awareness, and learning across the organization” (Arroyo et al, 2007). The knowledge gained using the toolbox is organized and analyzed, so mistakes, missed opportunities and lessons learned can be more easily identified.
A questioning organization and management team is one that makes decisions based on facts and research (Arroyo et al, 2007). The toolbox focuses on making well-informed decisions, therefore it can play a role in the clinic becoming a questioning organization. In conclusion, the Informed Decisions Toolbox was explained and Rebecca’s decision making process using the IDT was presented. Her decision to focus the clinic’s efforts on preventive medicine, STD/HIV prevention, and case management was supported by the research. The Four A’s tool was identified as the most helpful for decision making. In addition, the use of the toolbox and the affect on the clinic’s accountability, knowledge transfer, and becoming a questioning organization were explained. Ultimately, through use of the IDT, an informed decision has been made.

AIDS in action. (n.a.). Retrieved from
Arroyo, L., Butler, P.W., Curtis, P., Gibson, M., Graetz, I., Hsu, J. (2007, September-October). The informed decisions toolbox: tools for knowledge transfer and performance improvement. Journal of Healthcare Management, 52(5), 325+.
Background: the Affordable Care Acts new rules on preventive care. (n.d.). Retrieved from
Campos-Outcalt, D., Mickey, T., Weisbuch, J., & Jones, R. (2006). Integrating Routine HIV Testing into a Public Health STD Clinic. Public Health Reports, 121(2), 175-180. Retrieved from EBSCOhost.
Centers for medicare & medicaid services. (n.d.). Retrieved from
Cogan, J. (2011). The Affordable Care Act's preventive services mandate: breaking down the barriers to nationwide access to preventive services. Journal of Law, Medicine & Ethics, 39(3), 355-365. doi:10.1111/j.1748-720X.2011.00605.x
Maki, A. (2010, December 1). Prevention through awareness. The Daily News, p. .
Move to accountable care puts case managers in the spotlight. (2011). Hospital Case Management, 19(9), 129-131. Retrieved from EBSCOhost.
Shelby County Health Department. (n.d.). Retrieved from
The HIV epidemic and Memphis students. (n.d.). Retrieved from…...

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