Background: Guidelines fulfil a number of functions, for example to optimise care, improve quality of care, and reduce unwarranted variation. However in many healthcare systems, guidance on providing quality care with fewer resources – money, time, staff – is needed.
Objectives:
• to explore ways guidelines currently support quality care with fewer resources;
• to identify guidelines whose primary aim is to ‘cost less’; and,
• to propose strategies to develop ‘cost-saving’ recommendations.
Methods: We looked at how guidelines in a national programme currently support the use of fewer resources. We also searched for guidelines whose primary aim is to ‘cost less’, using the GIN International Guideline Library and the National Guideline Clearinghouse using free-text terms for costs and savings. Finally, we explored how committees can be supported in making ‘cost-saving’ recommendations.
Results: There are options for making recommendations which ‘cost less’ These include ‘do not do’ recommendations and recommendations on how to deliver care efficiently (service delivery). There is also increasing consideration of resource impact to ensure that where more resources are needed to implement recommendations, the evidence warrants this, and this is clearly communicated to guideline users.
We identified only 1 guideline that explicitly aimed to save costs.
Committees do not make as many negative (‘do not do’) recommendations as they do positive. Previous work has been presented at GIN on why this might be (such as concerns about evidence needed to support such recommendations). Practical ways to increase negative recommendations could include ensuring that where positive recommendations are made, committees consider actions that can then be stopped, such as medicines, technologies or procedures.
Conclusions: Guidelines that address cost containment or reduction are increasingly seen as key to the sustainability of many healthcare systems. All guidelines should consider if cost containment/reduction is appropriate and, if so, to ensure review questions address this, encourage committees to make recommendations, and make the potential for cost-savings clear.