Health services must use the best evidence if hopes of improving quality and saving money through better coordinated care are to be realised, new study finds

A new research report from the Health Foundation has found poor coordination of care leads to unacceptable harm and quality of care for patients but making changes that improve quality and save money is challenging. Success depends on the choice of the approach and how well it is implemented. The research also suggests the reform agenda needs to better support coordination with changes in payment systems, regulation, professional education and codes of practice required. 

'Does clinical coordination improve quality and save money?' was commissioned by the Health Foundation to help identify where and how improvements in quality can be made to inform policy makers, clinicians and managers.

The leading academic, Dr John Øvretveit, Director of Research and Professor at the Karolinska Institute Medical Management Centre in Stockholm, reviewed the evidence about clinical coordination and developed a guide for health services to the approaches with the strongest evidence.   

The report finds that the most cost-effective approaches are those which use good data to identify the patients most at risk of deterioration, which then actively reach-out to help those patients, and which effectively coordinate the right type of care and self-care services.

Dr John Øvretveit said:

'Quality improvement objectives and financial incentives have to go hand in hand in a tight financial climate if we are to speed up the more widespread implementation of proven improvements. The double benefit of higher quality and lower costs from value improvement can unite professionals, managers, payers and patients. But the research shows the types of changes have to be carefully chosen and made for particular local patients and settings if they are both to save money and raise quality.'

Martin Marshall, the Health Foundation’s Director of Research and Development, commented:

'The potential of current health reforms to either improve or fragment the healthcare system is being hotly contested in the UK, in part because of a concern about the impact that they might have on clinical cooperation. At a time of unprecedented change for the health service, it becomes all the more important that we keep sight of the evidence about what works to support effective clinical coordination.

'This report highlights many good ideas, but also reveals that attempts to replicate them need very careful consideration. By its nature, coordination is dependent on the local context; there is no "one size fits all" solution'.

The report highlights how changes in payment systems, regulation, professional education and codes of practice are needed to create environments to encourage coordination, and to counteract the increasing fragmentation and pressures around coordination.

Dr John Øvretveit adds: 'It is possible that those who suffer most from under coordination are people who are poor, vulnerable and/or from ethnic minorities. There is an ethical case for addressing this issue. There is also a good economic case – avoidable deterioration of their health is likely to result in higher costs for public health systems. Researchers have neglected these groups, perhaps even more than health providers have.'

The evidence shows that many changes for better care coordination have not been well-evaluated. The Health Foundation is pursuing further research into value for money in healthcare across a range of research projects, including macro level health economics analysis, examination of the comparative value of components of care pathways and the extent that patient collaboration can increase value for money in healthcare services.

Notes to editors

Dr John Øvretveit is Director of Research, and Professor of Health Innovation, Implementation and Evaluation at the Medical Management Centre, The Karolinska Institute, Stockholm.

His work is based on the belief that organisation and management can bring out the best and worst in people, and that the right organisation design is critical for effective healthcare. His work has a strong focus on ensuring practical research can contribute to better care for patients, and he has been previously commissioned by the Health Foundation to undertake a review of the evidence, 'Does improving quality save money?', and is currently working on a review of evidence about whether increasing patient involvement can raise quality and save money at the same time.