Abstract
Background/Aims Due to rising health care costs and wide variations in quality, the U.S. health care system is undergoing rapid changes that include payment reform and movement towards integrated delivery systems (IDSs). Well-established IDSs, such as Kaiser Permanente (KP), must begin to identify the specific system-level factors that results in superior patient outcomes in response to policymakers’ concerns. Comparative health systems research is one area that can provide insights into what particular aspects of the IDS results in improved care delivery. The objective of this systematic review was to examine the existing published studies on comparative health systems that relate to IDSs and KP to obtain a baseline understanding of the state of comparative health systems research to provide foundational knowledge. We also sought to identify the gaps in the literature on comparative health systems research.
Methods We conducted a literature search on PubMed and an internal KP Publications Library. Studies that compared KP as a system or organization to other health care systems, or across KP facilities internally were included. The literature search resulted in a total of 1,605 articles, of which 65 met the study inclusion and were examined by three reviewers.
Results The majority of comparative health system studies focused on intra-KP comparisons (n = 42). Fewer studies compared KP to other U.S. health care system (n = 15) or to international health care systems (n = 12).
Conclusions Of all studies published by or about KP, only a small proportion of articles were identified as being comparative health systems research. Additional empirical studies that compare the specific factors of the IDS model with other systems of care is urgently needed to better understand the “system-level” factors that result in improved and/or diminished care delivery.
