When Is Quality Improvement Cost Saving, Cost Effective, or Not a Good Value?

描述（由申请人提供）：医疗质量问题是常见的，包括必要的护理使用不足，过度使用不适当的护理和医疗差错。次优护理增加了可避免的医疗保健支出，特别是在疾病无法控制或出现并发症时，产生了需要更多治疗的指征。因此，提高质量可以节省资金的想法已经变得普遍，导致了相关的研究和政策。当质量改进策略为实施策略的人（如健康保险公司和提供商组织）节省了资金时，采用策略可能会自然而然地发生。然而，当执行者遭受经济损失时，即使由此带来的健康效益代表着良好的价值，也不太可能自发采用。但是，质量改进降低成本或代表良好价值的证据有多可靠呢？这似乎没有经过系统的研究。同样，与净节省有关的因素仍然未知。决策者还需要信息，使他们能够识别关于提高质量净成本的或多或少可信的主张。这个项目试图回答这些问题。因此，该项目有三个具体目标：(1)评估涉及质量改进成本的分析是否符合涉及经济评价的研究的基本标准；(2)通过应用新开发的质量成本框架，检查合格的分析是否包括与质量相关的成本类别；(3)确定提高护理质量节省成本、具有成本效益或两者都不具备的频率；并找出使储蓄更可能或更不可能的因素。实现这些目标将需要查明造成发病率和死亡率的主要原因的质量问题以及有关的国家政策。接下来，系统的文献综述将确定解决质量改进的相关经济分析。为了评估分析方法的质量，研究人员将使用德拉蒙德评估经济评估清单、ispr - smdm建模研究最佳实践和质量-成本框架。最后一步将需要从不同的角度检查提高质量是节省成本、具有成本效益还是不具有良好价值的频率；并确定质量改进策略的类型和与节约相关的具体质量问题。拟议的研究直接关系到AHRQ的使命和目标，具体来说：“医疗保健系统……提供高质量、高价值医疗保健的能力”；以及“为政策制定者提供评估系统变化对……质量……影响的能力”。和成本……”

DESCRIPTION (provided by applicant): Problems with the quality of medical care are common, including the underuse of necessary care, overuse of inappropriate care, and medical errors. Suboptimal care contributes to avoidable healthcare expenditures, particularly when diseases become uncontrolled or complications arise, creating indications for more treatment. Thus, the idea that quality improvement saves money has become widespread, leading to related research and policies. When a quality improvement strategy saves money for those implementing it, such as health insurers and provider organizations, adoption may occur spontaneously. However, when implementers experience financial losses, spontaneous adoption is less likely, even if the resulting health benefits represent a good value. But how robust is the evidence that quality improvement reduces costs, or represents a good value? This does not appear to have been examined systematically. Similarly, the factors associated with net savings remain unknown. Decision makers also need information enabling them to identify more and less credible claims about the net cost of improving quality. This project seeks to answer these questions. Accordingly, the project has three Specific Aims: (1) To assess whether analyses addressing the cost of quality improvement meet basic standards for research involving economic evaluation; (2) To examine whether eligible analyses include relevant categories of quality-related costs by applying the newly developed Quality-Cost Framework; and (3) To determine how frequently improving quality of care is cost-saving, cost-effective, or neither; and to identify factors that make savings more or less likely. Achieving these Aims will entail identifying quality problems contributing to leading causes of morbidity and mortality as well as pertinent national policies. Next, a systematic literature review will identify relevant economic analyses addressing quality improvement. To assess the analyses' methodological quality, investigators will use the Drummond Checklist for Assessing Economic Evaluations, the ISPOR-SMDM Best Practices for Modeling Studies, and the Quality-Cost Framework. The final step will entail examining how often improving quality is cost saving, cost-effective, or not a good value from various perspectives; and identifying the types of quality improvement strategies and specific quality problems associated with savings. The proposed research directly pertains to AHRQ's mission and goals, specifically: "the health care system's ability to...deliver high-quality, high-value healthcare;" and "providing policymakers with the ability to assess the impact of system changes on...quality...and cost..."