title: Comparative health systems research among Kaiser Permanente and other integrated delivery systems: a systematic literature review.
abstract: BACKGROUND
  Because of rising health care costs, wide variations in quality, and increased patient complexity, the US health care system is undergoing rapid changes that include payment reform and movement toward integrated delivery systems. Well-established integrated delivery systems, such as Kaiser Permanente (KP), should work to identify the specific system-level factors that result in superior patient outcomes in response to policymakers' concerns. Comparative health systems research can provide insights into which particular aspects of the integrated delivery system result in improved care delivery.
  
  
  OBJECTIVE
  To provide a baseline understanding of comparative health systems research related to integrated delivery systems and KP.
  
  
  METHODS
  Systematic literature review.
  
  
  METHODS
  We conducted a literature search on PubMed and the KP Publications Library. Studies that compared KP as a system or organization with other health care systems or across KP facilities internally were included. The literature search identified 1605 articles, of which 65 met the study inclusion criteria and were examined by 3 reviewers.
  
  
  RESULTS
  Most comparative health systems studies focused on intra-KP comparisons (n = 42). Fewer studies compared KP with other US (n = 15) or international (n = 12) health care systems. Several themes emerged from the literature as possible factors that may contribute to improved care delivery in integrated delivery systems.
  
  
  CONCLUSIONS
  Of all studies published by or about KP, only a small proportion of articles (4%) was identified as being comparative health systems research. Additional empirical studies that compare the specific factors of the integrated delivery system model with other systems of care are needed to better understand the "system-level" factors that result in improved and/or diminished care delivery.
authors.affiliation: Research Scientist at the Mid-Atlantic Permanente Research Institute in Rockville, MD. jared.maeda@gmail.com.
authors.forename: Jared Lane K
authors.initials: JL
authors.lastname: Maeda
authors.affiliation: Former Strategic Initiatives Manager for the Kaiser Foundation Research Institute in Oakland, CA. karen.michele.lee@gmail.com.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Lee
authors.affiliation: Executive Director of Research and Community Benefit for the Mid-Atlantic Permanente Research Institute in Rockville, MD. michael.horberg@kp.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Horberg
mesh_terms: D057186:Comparative Effectiveness Research; D003695:Delivery of Health Care / Q000592:standards*; D019033:Delivery of Health Care, Integrated / Q000592:standards; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D014481:United States