stabilized. No data were presented to directly support the recommendation for 50 poison prevention and control centers. Furthermore, no recommendations were presented regarding specific internal organizational structures, modes of operation, or the need to develop service quality measures. Finally, it was outside the scope of the study to compare the cost of poison control center service delivery with other delivery mechanisms such as emergency departments.

The data and analysis presented in this chapter are an effort to further explore and clarify these issues. The first section of this chapter focuses on a review of the economic evaluations of services delivered by poison control centers and the direct and indirect cost savings gained by using them. The second section describes the staffing and operational characteristics of centers, evaluates their economies of scale, and compares their organizational characteristics that exhibit contrasting values on size and efficiency.

In conducting these analyses, we used a variety of data sources, including the Toxic Exposure Surveillance System (TESS); nonaudited, self-reported survey data provided by the American Association of Poison Control Centers (AAPCC); statistical analysis of secondary data to explain variation in efficiency of poison control centers; and an analysis of qualitative interview data obtained from a sample of 10 poison control centers. 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), as Phillips and colleagues state: “The primary benefit of poison control centers is that they provide advice that allows poisonings to be appropriately handled at home or triaged to a health care facility, thereby avoiding unnecessary visits to health care facilities or inappropriate and potentially harmful home treatments.” They also serve as a free resource for those without primary care or with limited access to primary care. In 2002, Watson et al. (2003), using TESS data, found that public calls to a poison control center were managed in a non-health-care facility—usually in the patient’s home (74 percent); were treated in a health care facility (23 percent); and were referred to a health care facility but the patient did not go (2 percent). Indeed, it is the benefits of this triage role, as well as better health outcomes from the center’s interfacing with emergency departments, that are the focus of the peer-reviewed literature on economic costs.

A number of published studies provide cost-effectiveness and cost-



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