fining the information needed for a full-scale, definitive study of organizational efficiency and effectiveness.

As noted in Chapter 6, a number of published studies provide cost-effectiveness and cost-benefit analyses of various aspects of the poison control center system and some take account of the potential reduction in morbidity and mortality as benefits. In many of these studies the lack of data presents a challenge. Nonetheless, taken as a whole, this literature makes a convincing case that, at least in terms of treatment management guidance for the public, poison control centers save the health care system economic resources and save members of the public time, lost wages, and anxiety. The Committee found no studies that compare cost-effectiveness of service delivery models among poison control centers.

Also noted in Chapter 6, the Committee found a wide range of service delivery models, organizational structures, and financing arrangements among poison control centers that successfully deliver core services. Although an earlier study conducted on six poison control centers suggested possible economies of scale for service areas of 2 million people or more, the Committee found little conclusive evidence from its own analysis that economies of scale operate with respect to size of population served and poison control center costs. Costs were best predicted by variables related to staffing patterns and wage rates rather than hardware expenses, population served, or funding source. More complete data are needed to further explore this important concern.

The Committee’s qualitative analysis of 10 poison control centers indicated that the more efficient centers had lower staff turnover rates with fewer concerns about salaries and were more likely to (1) participate in partnerships or joint ventures in the community, (2) have written strategic plans specific to the poison control center, and (3) be organizationally affiliated with a private institution. Furthermore, the more efficient centers were less likely to cite problems related to complex reporting and accountability and problems of balancing core poison control functions with other activities such as research and bioterrorism response and preparedness. These results provide some indications of desirable (e.g., written strategic plans and participation in joint ventures) and undesirable organizational characteristics. It is important to note that these analyses were based solely on population served, cost per human exposure call, and penetrance.

The existing data are insufficient for the development of either contractual specifications or performance measures for a new Poison Prevention and Control System. The Committee suggests new data-gathering efforts to obtain original financial and performance data from existing poison control centers. These data are needed to guide future public funding of core activities.

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