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

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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..."