The association between health care quality and cost: a systematic review.
The association between health care quality and cost: a systematic review.
复制标题
DOI：
10.7326/0003-4819-158-1-201301010-00006
复制
发表时间：
2013-01-01
影响因子：
39.2
通讯作者：
Mehrotra A
中科院分区：
文献类型：
--
作者：
Hussey PS;Wertheimer S;Mehrotra A
虽然有广泛的政策共识，即控制成本和提高质量都是至关重要的，但人们对成本与质量之间的关系知之甚少。系统地回顾医疗质量和成本之间关联的证据。美国PubMed、EconLit和EMBASE数据库的电子文献检索- 1990年至2012年间发表的研究报告。标题、摘要和全文综述，以识别相关研究。两名评审员独立提取数据，通过共识协调差异。研究按分析水平、质量指标类型、成本指标类型和处理混杂因素的方法进行分类。在纳入的61项研究中，21项（34%）报告了阳性或混合阳性相关性（较高的成本与较高的质量相关）; 18项（30%）报告了阴性或混合阴性相关性; 22项（36%）报告了无差异、不精确或不确定的相关性或混合相关性。在许多研究中，这些关联具有低至中度临床意义。在9项使用工具变量分析来解决未观察到的患者健康状况混淆的研究中，7项（78%）报告了正相关性，但这些研究的其他特征可能影响了他们的发现。研究中广泛采用异质性方法和测量手段。该综述受到基础研究质量的限制。医疗保健成本和质量之间的关联方向的证据是不一致的。大多数研究发现，成本和质量之间的关联是小到中等，无论方向是积极的还是消极的。今后的研究应侧重于哪类支出对提高质量最有效，哪类支出是浪费。
Although there is broad policy consensus that both cost containment and quality improvement are critical, the association between costs and quality is poorly understood. To systematically review evidence of the association between health care quality and cost. Electronic literature search of PubMed, EconLit, and EMBASE databases for U.S.-based studies published between 1990 and 2012. Title, abstract, and full-text review to identify relevant studies. Two reviewers independently abstracted data with differences reconciled by consensus. Studies were categorized by level of analysis, type of quality measure, type of cost measure, and method of addressing confounders. Of 61 included studies, 21 (34%) reported a positive or mixed-positive association (higher cost associated with higher quality); 18 (30%) reported a negative or mixed-negative association; and 22 (36%) reported no difference, an imprecise or indeterminate association, or a mixed association. The associations were of low to moderate clinical significance in many studies. Of 9 studies using instrumental variables analysis to address confounding by unobserved patient health status, 7 (78%) reported a positive association, but other characteristics of these studies may have affected their findings. Studies used widely heterogeneous methods and measures. The review is limited by the quality of underlying studies. Evidence of the direction of association between health care cost and quality is inconsistent. Most studies have found that the association between cost and quality is small to moderate, regardless of whether the direction is positive or negative. Future studies should focus on what types of spending are most effective in improving quality and what types of spending represent waste.