The cost of efforts to improve quality

BACKGROUND. Virtually all hospitals in the United States report that they e ngage in efforts to improve quality, such as continuous quality improvement (CQI). Little is known about the costs of these efforts and whether they a re associated with improved outcomes or lower patient-care costs. OBJECTIVES. The principal objective of this study was to provide benchmark data on the costs of efforts to improve quality. The authors also attempted to determine if quality improvement expenditures are correlated with outco mes and/or condition-specific hospital costs, METHODS. Detailed information on the cost of quality improvement was obtain ed from hospitals participating in a broad study of CQI activities. These d ata were correlated with patient outcomes and condition-specific costs. The subjects were medium to large hospitals throughout the United States, Seni or managers provided budgetary information on direct costs of qualify impro vement, and details about meetings associated with quality improvement. The y also provided summary medical bills for all patients undergoing total hip replacement and coronary artery bypass graft surgery, The billing informat ion was combined with data provided by the Health Care Finance Administrati on to estimate condition-specific costs. Patients were directly surveyed to obtain information about satisfaction and outcomes. RESULTS. There is a wide range of expenditures on quality improvement activ ities. Meeting costs are a substantial percentage of total costs. Neither t otal costs nor meeting costs are correlated with condition-specific costs, DISCUSSION. Hospital managers can be expected to insist on evidence that qu ality improvement expenditures produce tangible benefits. This article prov ides benchmark estimates of those benefits and a methodology for further re search.