Health Care Efficiency Measures: Identification, Categorization, and Evaluation

Final Report

Designed for stakeholders, payers, and quality improvement and accrediting organizations, this report presents a comprehensive and impartial review of the evidence on efficiency measurement.

The goal of the Agency for Healthcare Research and Quality was to identify, analyze, and classify current definitions; lay out a linguistic roadmap to help illuminate discussions; and identify some next steps. 

Table of Contents

Disclaimer
Acknowledgements
Copyright
Preface
Executive Summary
Chapter 1. Introduction
Chapter 2. Methods
  Analytic Framework—A Typology of Efficiency
  Applying the Typology
  Approaches That We Do Not Classify as Efficiency Measures
  Economic Efficiency for Society as a Whole
  Evidence Sources and Searches
  Technical Expert Panel
  Title Screening, Article Review, and Selection of Individual Studies
  Peer Review Process
Chapter 3. Results
  Literature Flow
  Overview of Article Abstraction
  Additional Observations on Measurement Methods
  Overview of Vendors and Stakeholder Interviews
  Efficiency Measures Identified Through the Grey Literature Review
  A Sample of Stakeholders' Perspectives
Chapter 4. Evaluation of Health Care Efficiency Measures
  Important
  Scientifically Sound
  Feasible
  Actionable
  Application of Efficiency Measures
Chapter 5. Discussion
  Limitations
  Conclusions
  Future Research
References and Included Studies
List of Acronyms/Abbreviations

Appendixes
  Appendix A: Technical Typology
  Appendix B: Search Methodology
  Appendix C: Abstraction Tools
  Appendix D: Technical Expert Panel and Peer Reviewers
  Appendix E: Blinded Reviewer Comments
  Appendix F: List of Excluded Studies
  Appendix G: Evidence Tables

Disclaimer

This report is based on research conducted by the Southern California Evidence-based Practice Center-RAND Corporation under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 282-00-0005-21). The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. In addition, although the document has been reviewed for proper grammar and syntax, any editorial errors are the responsibility of the author(s).

The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.

This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report. 

Acknowledgements

Under Contract No. 282-00-0005-21, this document was funded by AHRQ and prepared by the Southern California Evidence-based Practice Center—RAND Corporation, Santa Monica, CA. Contributors include:

Principal Investigator:
Elizabeth A. McGlynn, Ph.D.

Evidence-based Practice Center Director:
Paul G. Shekelle, M.D., Ph.D.

Task Order Coordinator:
Susan Chen, B.A.

Economists:
Dana Goldman, Ph.D.
John Romley, Ph.D.

Content Experts:
Peter Hussey, Ph.D.
Han de Vries, M.Sc., M.Phil.
Margaret Wang, Ph.D.

Programmer:
Martha Timmer, M.S.

Database Manager:
Jason Carter, B.A.

Staff Assistant:
Carlo Tringale, B.A

Librarian:
Roberta Shanman, M.S. 

Copyright Information

This document is in the public domain and may be used and reprinted without permission except those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders.