Value in Health Care: Key Information for Policymakers to Assess Efforts to Improve Quality While Reducing Costs

摘要

The U.S. has devoted an increasing proportion of its economy and federal budget to the provision of health care services, but high levels of spending do not guarantee good care. Policymakers, health practitioners, and others have implemented numerous health care interventions that make discrete changes in the organization of health care services in order to enhance the value of health care--that is, improve the quality of care while reducing costs. Examples include programs to reduce bloodstream infections and to coordinate patient care following hospital discharges. This report (1) examines the availability of evidence on the effect of selected interventions on quality of care and costs; (2) identifies key dimensions for assessing the strength of such evidence; and (3) examines factors that can facilitate the implementation and replication of health care interventions. GAO identified a broad and diverse set of health care interventions using published and unpublished sources. For 127 of those interventions, GAO analyzed responses to a questionnaire that it sent to persons knowledgeable about available information on the effect of that particular intervention on quality of care and costs. GAO's questionnaire also asked respondents to assess the relative importance of seven factors in the implementation and potential replication of the health care intervention. In addition, GAO consulted the methodological literature and experts on assessing evidence on the effects of health care interventions.