Title: Improving the quality of health care in America: what medical schools, leading medical journals, and federal funding agencies can do
Abstract: As detailed in several recent prominent reports, American medicine is plagued with high rates of medical errors and complications, as well as an overall failure to ensure that therapeutic and preventive measures of known efficacy actually reach and benefit patients ( 1 Chassin M.R. Improving the quality of care. N Engl J Med. 1996; 335: 1060-1063 Crossref PubMed Scopus (189) Google Scholar , 2 Kohn L.T. Corrigan J.M. Donaldson M.S. To Err Is Human Building a Safer Health System. National Academy Press, Washington, DC2000 Google Scholar , 3 Allison J.J. Kiefe C.I. Weissman N.W. et al. Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI. JAMA. 2000; 284: 1256-1262 Crossref PubMed Scopus (268) Google Scholar ). These lapses in quality lead to poor outcomes and high costs. The quality movement applies to health care a set of process improvement methods that were pioneered for manufacturing industries ( 4 Bodenheimer T. The American health care system—the movement for improved quality in health care. N Engl J Med. 1999; 340: 488-492 Crossref PubMed Scopus (221) Google Scholar , 5 Leape L.L. Error in medicine. JAMA. 1994; 272: 1851-1857 Crossref PubMed Google Scholar , 6 Chassin M.R. Is health care ready for six sigma quality?. Milbank Q. 1998; 76: 565-591 Crossref PubMed Scopus (283) Google Scholar , 7 Berwick D.M. Continuous improvement as an ideal in health care. N Engl J Med. 1989; 320: 53-56 Crossref PubMed Scopus (1244) Google Scholar , 8 Lunnberg G.D. Wennberg J.E. A JAMA issue on quality of care a new proposal and a call to action. JAMA. 1997; 278: 1615-1616 Crossref PubMed Google Scholar ). These approaches focus on measuring quantifiable outcomes to define episodes of variance from an accepted range of values. Efforts are then made to reduce variance and continuously improve the process of care. As a result of this continuous process, patients with similar conditions receive similar treatments, and the processes of caring for these patients improve in consistency, quality, and cost. The algorithm for continuous process improvement involves repeated cycles of “plan, do, study, act.” This is a shorthand version of planning an intervention, doing it in a small sample of the process, measuring the effect of the intervention on the process that is to be improved, and acting to change the process based on the experience obtained. Increasingly, the literature demonstrates that these approaches lead to improved processes of care and decision making, improved outcomes for patients, and lowered costs ( 3 Allison J.J. Kiefe C.I. Weissman N.W. et al. Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI. JAMA. 2000; 284: 1256-1262 Crossref PubMed Scopus (268) Google Scholar , 4 Bodenheimer T. The American health care system—the movement for improved quality in health care. N Engl J Med. 1999; 340: 488-492 Crossref PubMed Scopus (221) Google Scholar , 5 Leape L.L. Error in medicine. JAMA. 1994; 272: 1851-1857 Crossref PubMed Google Scholar , 6 Chassin M.R. Is health care ready for six sigma quality?. Milbank Q. 1998; 76: 565-591 Crossref PubMed Scopus (283) Google Scholar , 7 Berwick D.M. Continuous improvement as an ideal in health care. N Engl J Med. 1989; 320: 53-56 Crossref PubMed Scopus (1244) Google Scholar ). Despite these successes and to the detriment of patient care, the medical community as a whole has been slow to adopt these approaches.
Publication Year: 2002
Publication Date: 2002-02-01
Language: en
Type: article
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 14
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