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

描述(由申请人提供)：医疗质量的问题很常见，包括必要的护理使用不足，过度使用不适当的护理，以及医疗差错。次优护理有助于避免可避免的医疗支出，特别是当疾病变得无法控制或出现并发症时，创造了更多治疗的指征。因此，质量改进节省资金的想法已经变得普遍，导致了相关研究和政策。当质量改进策略为那些实施它的人节省了资金时，例如健康保险公司和提供者组织，采用可能会自发发生。然而，当实施者遭受经济损失时，自发采用的可能性较小，即使由此产生的健康好处代表着良好的价值。但是，质量改进降低成本或代表良好价值的证据有多有力？这似乎没有得到系统的检查。同样，与净储蓄相关的因素仍不得而知。决策者还需要信息，使他们能够识别关于提高质量的净成本的可信度更高和更不可信的说法。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)评估关于质量改进成本的分析是否符合涉及经济评估的研究的基本标准；(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相关类别的质量相关成本；(3)确定改善护理质量的频率是节约成本、成本效益，还是两者都不节省；以及找出使节省的可能性更大或更不可能的因素。要实现这些目标，就必须查明导致发病率和死亡率的主要原因的质量问题以及相关的国家政策。接下来，系统的文献回顾将确定解决质量改进问题的相关经济分析。为了评估分析的方法质量，研究人员将使用德拉蒙德经济评估核对表、ISPOR-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成本节约、成本有效还是不是好的价值的频率；并确定与节省相关的质量改进策略的类型和具体的质量问题。拟议的研究与AHRQ的使命和目标直接相关，特别是：“医疗保健系统的能力……提供高质量、高价值的医疗保健”；以及“使决策者能够评估系统变化对……质量……和成本的影响……”。

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..."