Integrated delivery systems for health care in the USA are associated with positive effects on quality of care
Citation: Hwang W, Chang J, LaClair M, et al. Effects of integrated delivery system on cost and quality. American Journal of Managed Care 2013; 19: e175-84
What is this? The COVID-19 pandemic is placing a strain on healthcare services. Existing research on the effects of integrated healthcare delivery systems (which are organised and coordinated systems managed by a financial entity) may provide useful information for policy makers.
In this systemic review, the authors searched for research evaluating the effects of integrated delivery systems in the USA on healthcare costs and quality. They restricted their search to studies published between 2000 and 2011, which were specific to the health system in the USA. They identified 21 peer-reviewed and 4 non-peer reviewed articles, and impacts on cost were assessed in 8 of these (5 peer-reviewed, 2 non-peer reviewed).
What was found: Most studies showed an association between increased integration of healthcare systems in the USA and improvement in quality of care with respect to, for example, clinical effectiveness, length of stay, medication error, number of office visits, hospital admission rates and rates of adverse health outcomes; but it is uncertain whether the improvements are due to integration or to associated characteristics (e.g. greater use of electronic medical records and systematic quality improvement initiatives).
Several studies found that patients treated for chronic diseases at integrated delivery systems in the USA had better outcomes.
Several studies found improvements in preventative care in integrated delivery systems in the USA.
There was some evidence of lower healthcare costs in integrated delivery systems in the USA.
The evidence for lower healthcare costs in integrated delivery systems in the USA is weak.
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