The quality and implications of Balance of Care studies: Lessons from a systematic literature review

The Balance of Care approach provides a framework for assessing the relative costs and outcomes of changes in the mix of services provided for a particular client group in a defined geographical area. A 2008/2009 systematic literature review explored how five key aspects of the framework had been operationalised detailing past studies' methods. However, little has been reported about the quality of these applications, whilst the (positive and negative, internal and external) issues associated with organisations' capacity to implement study findings (i.e. reconfigure provision) have not been appraised. Against this background, this paper reports the results of a new review that sought to address these gaps and identified 38 examples of the approach's use since 1970. Reporting standards appeared to have improved over time, but there was no clear relationship between study quality and year of publication. Recent applications generally had large samples, used credible case types and engaged appropriate personnel in specifying optimal care. However, they rarely considered comprehensive costs, cost shifting or outcomes. Factors perceived to assist service reconfiguration included the high quality data the approach provided and the momentum for change it generated. Negative factors were predominantly financial, including increased average unit costs and the need for bridging funds.