Contextual factors influencing cost and quality decisions in health and care: a structured evidence review and narrative synthesis

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@article{9212a63573a54e539674badc3701b8bd,
title = "Contextual factors influencing cost and quality decisions in health and care: a structured evidence review and narrative synthesis",
abstract = "Background: Decisions affecting cost and quality are taken across health and care but investigation of the mediating role of context in these is in its infancy. This paper presents a synthesis of the evidence on the contextual factors that influence {\textquoteleft}decisions of value{\textquoteright} – defined as those characterised by having a significant and demonstrable impact on both quality and resources – in health and care. The review considers the full range of resource/quality decisions and synthesises knowledge on the contextual drivers of these.Methods: The method involved structured evidence review and narrative synthesis. Literature was identified through searches of electronic databases (HMIC, Medline, Embase, CINAHL, NHS Evidence, Cochrane, Web of Knowledge, ABI Inform/Proquest), journal and bibliography hand-searching and snowball searching using citation analysis. Structured data extraction was performed drawing out descriptive information and content against review aims and questions. Data synthesis followed a thematic approach in accordance with the varied nature of the retrieved literature.Results: Twenty-one literature items reporting 14 research studies and seven literature reviews met the inclusion criteria. The review shows that in health and care contexts, research into decisions of value in health and care is in its infancy and contains wide variation in approach and remit. The evidence is drawn from a range of service and country settings and this reduces generalisability or transferability of findings. An area of relative strength in the published evidence is inquiry into factors influencing coverage and commissioning decisions in health care systems. Allocative decisions have therefore been more consistently researched than technical decisions. We use Pettigrew{\textquoteright}s (1985) distinction between inner and outer context to structure analysis of the range of factors reported as being influential. These include: evidence/ information, organisational culture and governance regimes, and; economic and political conditions.Conclusion: Decisions of value in health and care are subject to range of intersecting influences that often lead to a departure from narrow notions of rational decision-making. Future research should pay greater attention to the relatively under-explored area of technical, as opposed to allocative, decision-making.",
keywords = "healthcare decision-making, cost, quality, literature review, health management",
author = "Iestyn Williams and Hilary Brown and Paul Healy",
year = "2018",
month = feb,
day = "28",
doi = "10.15171/ijhpm.2018.09",
language = "English",
volume = "7",
journal = "International Journal of Health Policy and Management",
issn = "2322-5939",
publisher = "Kerman University of Medical Sciences",
number = "8",

}

RIS

TY - JOUR

T1 - Contextual factors influencing cost and quality decisions in health and care

T2 - a structured evidence review and narrative synthesis

AU - Williams, Iestyn

AU - Brown, Hilary

AU - Healy, Paul

PY - 2018/2/28

Y1 - 2018/2/28

N2 - Background: Decisions affecting cost and quality are taken across health and care but investigation of the mediating role of context in these is in its infancy. This paper presents a synthesis of the evidence on the contextual factors that influence ‘decisions of value’ – defined as those characterised by having a significant and demonstrable impact on both quality and resources – in health and care. The review considers the full range of resource/quality decisions and synthesises knowledge on the contextual drivers of these.Methods: The method involved structured evidence review and narrative synthesis. Literature was identified through searches of electronic databases (HMIC, Medline, Embase, CINAHL, NHS Evidence, Cochrane, Web of Knowledge, ABI Inform/Proquest), journal and bibliography hand-searching and snowball searching using citation analysis. Structured data extraction was performed drawing out descriptive information and content against review aims and questions. Data synthesis followed a thematic approach in accordance with the varied nature of the retrieved literature.Results: Twenty-one literature items reporting 14 research studies and seven literature reviews met the inclusion criteria. The review shows that in health and care contexts, research into decisions of value in health and care is in its infancy and contains wide variation in approach and remit. The evidence is drawn from a range of service and country settings and this reduces generalisability or transferability of findings. An area of relative strength in the published evidence is inquiry into factors influencing coverage and commissioning decisions in health care systems. Allocative decisions have therefore been more consistently researched than technical decisions. We use Pettigrew’s (1985) distinction between inner and outer context to structure analysis of the range of factors reported as being influential. These include: evidence/ information, organisational culture and governance regimes, and; economic and political conditions.Conclusion: Decisions of value in health and care are subject to range of intersecting influences that often lead to a departure from narrow notions of rational decision-making. Future research should pay greater attention to the relatively under-explored area of technical, as opposed to allocative, decision-making.

AB - Background: Decisions affecting cost and quality are taken across health and care but investigation of the mediating role of context in these is in its infancy. This paper presents a synthesis of the evidence on the contextual factors that influence ‘decisions of value’ – defined as those characterised by having a significant and demonstrable impact on both quality and resources – in health and care. The review considers the full range of resource/quality decisions and synthesises knowledge on the contextual drivers of these.Methods: The method involved structured evidence review and narrative synthesis. Literature was identified through searches of electronic databases (HMIC, Medline, Embase, CINAHL, NHS Evidence, Cochrane, Web of Knowledge, ABI Inform/Proquest), journal and bibliography hand-searching and snowball searching using citation analysis. Structured data extraction was performed drawing out descriptive information and content against review aims and questions. Data synthesis followed a thematic approach in accordance with the varied nature of the retrieved literature.Results: Twenty-one literature items reporting 14 research studies and seven literature reviews met the inclusion criteria. The review shows that in health and care contexts, research into decisions of value in health and care is in its infancy and contains wide variation in approach and remit. The evidence is drawn from a range of service and country settings and this reduces generalisability or transferability of findings. An area of relative strength in the published evidence is inquiry into factors influencing coverage and commissioning decisions in health care systems. Allocative decisions have therefore been more consistently researched than technical decisions. We use Pettigrew’s (1985) distinction between inner and outer context to structure analysis of the range of factors reported as being influential. These include: evidence/ information, organisational culture and governance regimes, and; economic and political conditions.Conclusion: Decisions of value in health and care are subject to range of intersecting influences that often lead to a departure from narrow notions of rational decision-making. Future research should pay greater attention to the relatively under-explored area of technical, as opposed to allocative, decision-making.

KW - healthcare decision-making

KW - cost

KW - quality

KW - literature review

KW - health management

U2 - 10.15171/ijhpm.2018.09

DO - 10.15171/ijhpm.2018.09

M3 - Review article

VL - 7

JO - International Journal of Health Policy and Management

JF - International Journal of Health Policy and Management

SN - 2322-5939

IS - 8

ER -