Exploring cost and quality: community-based versus traditional hospital delivery systems

This article presents two approaches for comparison studies of cost and quality outcomes between community-based and traditional hospital systems of care. Two methodologies are used specifically to compare midwifery practice in a free-standing birth center to traditional obstetric practice with hospital deliveries. Findings from both studies reinforce the potential cost savings of community-based care without compromising quality. The methodologies used here can be applied to other settings. These approaches are also relevant for comparison studies of cost and quality outcomes between physicians and other nonphysician providers such as physician assistants and nurse practitioners, who frequently staff emerging models of community-based care. Issues related to obtaining comparable clinical and cost data versus reimbursement for both community-based and hospital care will be highlighted.