Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 7, Issue 1, 2004. Pages: 15-21

Published Online: 15 Mar 2004

Toward a Model for Testing the Relationship Between Quality of Care and Costs

Barbara Dickey¹* and Sharon-Lise T. Normand²

¹PhD, Associate Professor, Harvard Medical School, Cambridge, MA, USA
²PhD, Associate Professor, Harvard Medical School, Harvard School of Public Health, Boston, MA, USA

* Correspondence to: Barbara Dickey, PhD, Department of Psychiatry, The Cambridge Hospital, 1493, Cambridge Street, Cambridge, MA 02139, USA
Tel.: +1-617-503 8441
Fax: +1-617-503 8470
E-mail: barbara_dickey@hms.harvard.edu

Source of Funding: NIMH R01 MH54076

Abstract

The growth of evidence-based medicine must be matched by efforts to assess the costs of adherence to practice guidelines. This paper provides a conceptual model and tests its usefulness in determining the cost of care that meets evidence-based standards. Using a case study, a conceptual model for determining the costs of evidence-based care is presented. Adults treated for an acute episode of schizophrenia whose medication met guideline standards were compared to those who had higher than recommended doses of anti-psychotic medication. Clinical benefits to patients were the same, but those with medication dose that did meet the guidelines had higher psychiatric treatment costs as well as more side-effects. The pressure of fiscal restraints needs to be balanced with information about what the cost will be to provide recommended treatment. The conceptual model faces many challenges in application, but shows promise as one approach to determining the cost of evidenced based care.

Background: In mental health services research there is little empirical evidence to support speculation about the relationship between costs and quality.
Aims of the Study: The purpose of this paper is to provide a conceptual model and test its usefulness in determining the cost of care that meets evidence-based standards.
Methods: A case study of individuals treated for an acute episode of schizophrenia is described and a conceptual model for determining the costs of evidence-based care is presented. Statistical tests of difference were used to compare two groups, those with care that met guideline standards and those that did not.
Results: Compared to care that did not meet recommendations, evidence-based care was cheaper. Clinical benefits to patients were the same, but those with poor care (higher than recommended doses of anti-psychotic medication) had higher treatment costs as well as more side-effects.
Discussion: The conceptual model faces many challenges in application, but shows promise as one approach to determining the cost of evidenced based care.
Implications for Health Care Provision and Use: The results support efforts to encourage clinicians to follow practice guidelines.
Implications for Health Policies: The growth of evidence-based medicine must be matched by efforts to assess the costs of adherence to practice guidelines. The pressure of fiscal restraints needs to be balanced with information about what the cost will be to provide recommended treatment.
Implications for Further Research: The greatest effort needs to be in the conceptual development of the model so that we can confidently estimate the costs and effectiveness of evidence-based treatment recommendations.

Received 7 July 2003; accepted 27 January 2004