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Performance of integrated delivery systems: quality, service and cost implications

Michael Leibert (Management Department, College of Business Administration, Missouri State University, Springfield, Missouri, USA)

Leadership in Health Services

ISSN: 1751-1879

Article publication date: 19 July 2011




Healthcare services in the USA have been described as being fragmented and uncoordinated. Integrated delivery systems are frequently promoted as being instrumental in efforts to improve the coordination of care and, thus, enhancing the quality of clinical care and patient services while ensuring optimum cost‐efficiencies. This study seeks to analyze and compare the performance of hospitals participating in highly integrated systems with non‐integrated hospitals based on outcome measures involving hospital performance.


The study compares the performance of 50 flagship hospitals participating in the most highly integrated delivery systems in the USA with a representative sample of non‐system hospitals utilizing one‐way analysis of variance. The comparative analysis was based on three key performance measures; clinical quality of medical care, patient satisfaction, and cost‐efficiency considerations.


The results of the review demonstrate that there is a statistically significant positive difference between the clinical quality performance of the highly integrated hospitals compared with the quality performance of non‐highly integrated facilities. No difference was identified between the two sample groups of hospitals for the performance measures related to patient satisfaction or cost‐efficiencies.


The study is an attempt to evaluate the implications and effectiveness of integration within the health care delivery system. It suggests that integrated delivery systems may provide the organization structure appropriate to help support and enhance the quality of clinical care for patients.



Leibert, M. (2011), "Performance of integrated delivery systems: quality, service and cost implications", Leadership in Health Services, Vol. 24 No. 3, pp. 196-206.



Emerald Group Publishing Limited

Copyright © 2011, Emerald Group Publishing Limited

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