Effects of Integrated Delivery System on Cost and Quality
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abstract
ntegrated health systems are often portrayed as the most effective in providing high-quality care at lower costs. This systematic review assesses the empirical evidence. Objectives: To perform a systematic review of the current literature to assess the association between integrated healthcare delivery systems and changes in cost and quality. Methods : Medline, Embase, Cochrane Reviews, Academic Search Premier, and reference lists were used to retrieve peer-reviewed articles reporting outcomes (cost and quality) related to integrated delivery systems. A general Internet search and reference lists were used to retrieve nonpeer reviewed publications meeting the same criteria. Included peer and nonpeer reviewed publications were based in the United States and were published between the years 2000 and 2011. Results: A total of 21 peer-reviewed articles and 4 nonpeer reviewed manuscripts met the inclusion criteria. Twenty studies showed an association between increased integration in healthcare delivery and an increase in the quality of care. One study reported no changes in quality indicators associated with increased integration. None of these studies measured cost reduction directly, but used reduction in utilization of services instead. Four studies associated decreases in the utilization of services with increases in integration. Conclusions: The vast majority of studies we reviewed have shown that integrated delivery systems have positive effects on quality of care. Few studies linked use of an integrated delivery system to lower health service utilization. Only 1 study reported some small cost savings.
