Toward a model for testing the relationship between quality of care and costs.
BACKGROUND
In mental health services research there is little empirical evidence to support speculation about the relationship between costs and quality.


OBJECTIVE
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.


CONCLUSIONS
The conceptual model faces many challenges in application, but shows promise as one approach to determining the cost of evidenced based care.


CONCLUSIONS
The results support efforts to encourage clinicians to follow practice guidelines.


CONCLUSIONS
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.


CONCLUSIONS
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.
Dickey
Barbara
B
Harvard Medical School, Cambridge, MA 02139, USA. barbara_dickey@hms.harvard.edu
Normand
Sharon-Lise T
SL
D000328:Adult; D019317:Evidence-Based Medicine / Q000191:economics; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008404:Massachusetts; D008605:Mental Health Services / Q000191:economics* / Q000592:standards*; D008875:Middle Aged; D017059:Models, Econometric; D019982:Organizational Case Studies; D011446:Prospective Studies; D011787:Quality of Health Care / Q000191:economics*; D012559:Schizophrenia / Q000191:economics / Q000628:therapy*