• Quality improvement
• Cost-effectiveness
• Healthcare quality improvement

With public reporting and value-based payment, healthcare organisations have strong incentives to optimise quality of care, improve patient outcomes and lower costs.1 In response, organisations are implementing diverse and often novel quality improvement (QI) interventions (systematic efforts to improve the structure, process or outcome of care). Many organisations routinely assess the clinical effects and costs of QI interventions to support internal decisions about whether to discontinue, sustain or expand them.

These internal analyses create an opportunity for QI teams to publish their experiences and inform decision-making at peer organisations. Since QI interventions can be labour-intensive and thus costly, published economic evaluations are of great interest to leaders weighing decisions about whether to adopt them and how best to implement them. Published evaluations seek to answer a two-part question about the effectiveness and cost of a specific QI intervention at one healthcare organisation, with the goal of reporting results that other organisations can use to inform their decisions. QI interventions that both improve quality and lower costs, relative to usual care, are a priority for widespread adoption.

Despite the frequency of internal cost analyses and the value of this information to external organisations, published economic evaluations remain scarce and those published are seldom high quality.1–4 This viewpoint explores how published economic evaluations could better meet the information needs of organisational leaders and align with the capabilities of QI teams seeking to publish their work.

Ideally, published analyses would use an evaluation approach applicable to this question, have high internal validity (trustworthy results), have good external validity (generalisability) and be transparent and interpretable by readers. Applicability to a particular question depends on the analytical perspective, time horizon, costing framework and clinical outcome measures.5–7 For QI, organisational leaders are likely to be most interested in performance on targeted quality measure(s) …