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Journal Watch: Economic Impact of Integrated Care

Special Report: What is the evidence on the economic impacts of integrated care? Nolte, Ellen; Pitchforth, Emma

Readers of IH Executive have an interest in—some might say passion for—learning the impacts integrated care has on patients and other stakeholders in the healthcare system. Clearly, one of the aims of better care integration and coordination is the economic impact. This published document by Ellen Nolte and Emma Pitchforth is based on a report commissioned by the World Health Organization (WHO), acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies. This policy summary is one of a  series to meet the needs of policymakers and health system managers. The aim is to develop key messages to support evidence-informed policymaking.

In this installment of the WHO series, the authors conducted a comprehensive literature review of published research and reports on the economic impact of integrated care. Among the key findings in the report:

None of the reviews identified by the searches explicitly defined ‘integrated care’ as the topic of review. 

  • The most common concepts or terms were case management, care coordination, collaborative care or a combination of these; four reviews focused on disease-management interventions. The majority of reviews considered a wide range of approaches, and typically only about half of primary studies included in individual reviews could be considered as integrated care under their definition.

 Utilization and cost were the most common economic outcomes assessed by reviews, but reporting of measures was inconsistent and the quality of the evidence was often low.

  • The majority of economic outcomes focused on hospital utilization through (re)admission rates, length of stay or admission days and emergency department visits.
  • Findings tended to be mixed within each review, which makes it difficult to draw firm conclusions.
  • Also, results were commonly not quantified, making an overall assessment of the size of possible effects problematic.

 There is evidence of cost–effectiveness of selected integrated care approaches, but the evidence base remains weak.

  • There was some evidence from one review of approaches targeting frequent hospital emergency department users that found one trial to report the intervention to be cost-effective.
  • Based on one economic evaluation, one other review concluded that there was little or no evidence of incremental quality-adjusted life year (QALY) gain over usual care of structured home-based, nurse-led health promotion for older people at risk of hospital or care home admission.

 The main takeaway from this report is that those of us who are leading the integrated care transition need to develop a more robust body of evidence that what we are promoting, and arguably doing, makes a difference in patient outcomes and the cost of care. We know it makes a difference, but it’s not real until someone else proves that it makes a difference!

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