Toward a model for testing the relationship between quality and costs

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. (March 2004)