IMPORTANCE Quality improvement (QI) interventions can reduce hospital readmission, but little is known about their economic value. OBJECTIVE To systematically review economic evaluations of QI interventions designed to reduce readmissions. DATA SOURCES Databases searched included PubMed, Econlit, the Centre for Reviews & Dissemination Economic Evaluations, New York Academy of Medicine's Grey Literature Report, and Worldcat (January 2004 to July 2016).STUDY SELECTION Dual reviewers selected English-language studies from high-income countries that evaluated organizational or structural changes to reduce hospital readmission, and that reported program and readmission-related costs.DATA EXTRACTION AND SYNTHESIS Dual reviewers extracted intervention characteristics, study design, clinical effectiveness, study quality, economic perspective, and costs. We calculated the risk difference and net costs to the health system in 2015 US dollars. Weighted least-squares regression analyses tested predictors of the risk difference and net costs. MAIN OUTCOMES AND MEASURESMain outcomes measures included the risk difference in readmission rates and incremental net cost. This systematic review and data analysis is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. RESULTSOf 5205 articles, 50 unique studies were eligible, including 25 studies in populations limited to heart failure (HF) that included 5768 patients, 21 in general populations that included 10 445 patients, and 4 in unique populations. Fifteen studies lasted up to 30 days while most others lasted 6 to 24 months. Based on regression analyses, readmissions declined by an average of 12.1% among patients with HF (95% CI, 8.3%-15.9%; P < .001; based on 22 studies with complete data) and by 6.3% among general populations (95% CI, 4.

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Regional differences remained stable during this time period although the reasons for these differences are speculative. Similarly, how and whether the gender difference in work hours and shift to younger anesthesiologists during this period will impact workforce needs is uncertain.

OBJECTIVEQuality improvement (QI) interventions can improve glycemic control, but little is known about their value. We systematically reviewed economic evaluations of QI interventions for glycemic control among adults with type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODSWe used English-language studies from high-income countries that evaluated organizational changes and reported program and utilization-related costs, chosen from PubMed, EconLitWe extracted data regarding intervention, study design, change in HbA 1c , time horizon, perspective, incremental net cost (studies lasting £3 years), incremental costeffectiveness ratio (ICER) (studies lasting ‡20 years), and study quality. Weighted least-squares regression analysis was used to estimate mean changes in HbA 1c and incremental net cost. RESULTSOf 3,646 records, 46 unique studies were eligible. Across 19 randomized controlled trials (RCTs), HbA 1c declined by 0.26% (95% CI 0.17-0.35) or 3 mmol/mol (2 to 4) relative to usual care. In 8 RCTs lasting £3 years, incremental net costs were $116 (95% CI 2$612 to $843) per patient annually. Long-term ICERs were $100,000-$115,000/quality-adjusted life year (QALY) in 3 RCTs, $50,000-$99,999/QALY in 1 RCT, $0-$49,999/QALY in 4 RCTs, and dominant in 1 RCT. Results were more favorable in non-RCTs. Our limitations include the fact that the studies had diverse designs and involved moderate risk of bias. CONCLUSIONSDiverse multifaceted QI interventions that lower HbA 1c appear to be a fair-to-good value relative to usual care, depending on society's willingness to pay for improvements in health.

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