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International Journal for Quality in Health Care Advance Access published online on March 23, 2005
International Journal for Quality in Health Care, doi:10.1093/intqhc/mzi034
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International Journal for Quality in Health Care © The Author 2005. Published by Oxford University Press on behalf of International Society for Quality in Health Care; all rights reserved
Accepted February 4, 2005

Article

The insufficiency of evidence to establish the business case for quality

Kerry E. Kilpatrick 1*, Kathleen N. Lohr 1, Sheila Leatherman 1, George Pink 1, Jean M. Buckel 1, Caroline Legarde 1, and Lynn Whitener 2

1 University of North Carolina at Chapel Hill, Department of Health Policy and Administration, Chapel Hill, NC, USA
2 University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC, USA

* To whom correspondence should be addressed.
Kerry E. Kilpatrick, E-mail: kerry_kilpatrick{at}unc.edu


  Abstract

Purpose. To determine whether a positive financial return on investment for quality-enhancing interventions is more likely for particular health conditions, in specific organizational settings, or with the use of particular interventions.

Data sources. Electronic search of MEDLINE®.

Data extraction. Search keywords included: business case, cost-effectiveness, cost-benefit, return on investment, costs, cost savings, quality, quality improvement, and program evaluation.

Results. Only 15 of 1968 articles identified contained sufficient information on both the costs of implementing quality-enhancing interventions and the resultant changes in costs of care or revenues to permit the calculation of a return on investment.

Conclusions. Scant attention is currently paid in the quality-of-care literature to the cost of implementing quality-enhancing interventions. To understand which quality-enhancing interventions are likely to produce positive returns on investments, data collection and analysis must include tracking the investment and operating costs of implementing the intervention as well as the changes in revenues and costs that result from the intervention.

Keywords: cost of care, health services utilization, quality-enhancing intervention, quality of care, return on investment.
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