Overview
Introduction
Measurement: Process and Outcome Indicators
Methods of Quality Improvement
Things Quality Improvement is NOT
Summative Experience
Summary

Quality in Healthcare

If you wanted to get a sense of the quality of healthcare delivery, how would you go about it?

  • You could ask each of the providers if they were following the guidelines for a specific disease
  • You could ask providers to keep track of their errors or “near misses”

Can you imagine any reason these methods may not work?

Earnest Interviewer: Have any of your patients gotten worse because of treatment you provided?
Reluctant Provider: Er, um… No, never, of course not.
EI: Do you use the approved guidelines for this condition?
RP: Of course—every time!
EI: What about the time . . . ?
RP: (interrupting) Well, that was a special case.


These methods would be fraught with problems of validity and reliability. Self-report of errors is shown to be low and, particularly if there is a potential punitive response, reporting would be infrequent and inaccurate.

This leaves us with a deficit in how we can assess quality.

 

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