Hospitals Bending the Cost Curve With Increased Quality: A Scoping Review Into Integrated Hospital Strategies

Abstract

Background: A lack of knowledge exists on real world hospital strategies that seek to improve quality, while reducing or containing costs. The aim of this study is to identify hospitals that have implemented such strategies and determine factors influencing the implementation. Methods: We searched PubMed, EMBASE, Web of Science, Cochrane Library and EconLit for case studies on hospital-wide strategies aiming to increase quality and reduce costs. Additionally, grey literature databases, Google and selected websites were searched. We used inductive coding to identify factors relating to implementation of the strategies. Results: The literature search identified 4198 papers, of which our included 17 papers describe 19 case studies from five countries, mostly from the US. To accomplish their goals, hospitals use different management strategies, such as continuous quality improvement, clinical pathways, Lean, Six Sigma and value-based healthcare. Reported effects on both quality and costs are predominantly positive. Factors identified to be relevant for implementation were categorized in eleven themes: 1) strategy, 2) leadership, 3) engagement, 4) reorganization, 5) finances, 6) data and information technology (IT), 7) projects, 8) support, 9) skill development, 10) culture, and 11) communication. Recurring barriers for implementation are a lack of physician engagement, insufficient financial support, and poor data collection. Conclusion: Hospital strategies that explicitly aim to provide high quality care at low costs may be a promising option to bend the cost curve while improving quality. We found a limited amount of studies, and varying contexts across case studies. This underlines the importance of integrated evaluation research. When implementing a quality enhancing, cost reducing strategy, we recommend considering eleven conditions for successful implementation that we were able to derive from the literature.

Ways to Improve Hospital Quality - A Health System Perspective Comment on "Hospitals Bending the Cost Curve With Increased Quality: A Scoping Review Into Integrated Hospital Strategies"

“…Thus, studies that focus on particular quality dimensions in particular countries and identify the effect by using high methodological standards may contribute to a deeper understanding of incentives provided by different institutional settings and their respective effects on quality of hospital care. These studies directly relate to the hopital level quality managment initiatives described in Wackers et al [1] . For example, Brekke et al 2 studied the impact of exposing hospitals in a National Health Service to non-price competition by exploiting a market based reform that increased patient choice in Norway in 2001.…”

“…Endnotes [1] More recent studies look at competition effects on hospitals in markets with fixed prices and are specific on how they adress competition and exploit high methodolgical standards.…”

Better Patient Outcomes at Less Cost: An Effective Strategy for Neurology Care

“…There are numerous examples, however, that prove otherwise. 2 Particularly since the introduction in the 1980s of quality improvement principles from the automotive industry into health care, there is increasing evidence that health care costs can be reduced while improving patient outcomes. This has been achieved by identifying sources of expenditures that provide no incremental health benefit and putting in place change strategies and programs that purposefully aim to reduce cost and improve quality.…”

“…From their experience, physicians may believe that lowering costs will risk poorer outcomes. There are numerous examples, however, that prove otherwise 2 . Particularly since the introduction in the 1980s of quality improvement principles from the automotive industry into health care, there is increasing evidence that health care costs can be reduced while improving patient outcomes.…”

Peer Review in der Intensivmedizin

“…3). In dieser Systematik ist der Verbesserungsprozess ein stetiger Kreislauf aus Messen, Bewerten, Ableiten von Maßnahmen und erneuter Messung als Erfolgskontrolle, um damit erfolgreich eine kontinuierliche Qualitätsverbesserung (Continuous Quality Improvement)[31] sicherzustellen.…”