Medical Care — research, quality improvement and program evaluation

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It sounds like a paradox:  science studying itself.  But, that is exactly what is happening in medicine.  Basic research has led to applications of the research and the applications are studied for effects, benefits and cost.   For example:  invent robotic surgery and apply it to patients, then set it up as a program in an operating room and try to improve the technique and patient selection, and finally evaluate the program to see if it meets stated goals of quality and cost and decide if it should continue and under what conditions.

This huge simplification helps with terms doctors and hospitals often talk about:

  • Discover and apply — called research.
  • Try to improve — called quality improvement (QI).
  • Continue the effort? — called program evaluation (PE).

Patients can be subjects of research.  But, participation in research requires explicit permission since the outcome is not known and it could be bad.

If we knew what it was we were doing, it would not be called research, would it?    (Albert Einstein)

Patients are hopefully impacted by quality improvement since the purpose is to make things better and thus no patient permission is required.  As part of QI a hospital may try to make sure antibiotics are given before surgery because there is research evidence the practice reduces infection.  Quality improvement focuses on a cycle of planning, doing, study and revision.  QI has become a huge area of study with numerous books and journals on the subject.  Virtually every hospital has a quality manager who is charged with improving the care at a hospital.

Patients are only indirectly affected by program evaluation.  Clinics and hospitals constantly evaluate programs for positive or negative effects.  Whether programs continue depend on such studies.  People may read about evaluation of medical programs like care at VA hospitals and may be impacted by decisions of policy makers based on such evaluations.  PE is likewise an important and growing discipline.

The concepts of research, quality improvement and program evaluation do tend to overlap.  One could imagine using QI techniques to improve the quality of research.  And, one could imagine research to find the fastest way to do program evaluation.  However, research is mainly for the purpose the researcher decides.  Whereas QI and PE are mainly for patient care, business or institutional purposes.

Quality healthcare depends on QI and PE.  Patients often don’t see these efforts in action.  But, ineffective QI and PE are hazardous to your health.  Although doctors and hospitals don’t like the idea:   law suits are a warning flag of inadequate QI and PE.

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  1. #1 by Chuck Schauberger on July 4, 2014 - 5:36 AM

    Great explanation of the different elements to improving healthcare, Ralph. Do you rank order them for importance in impact for patients? Obviously, program evaluation is about making sure we are directing our resources to programs that will make a difference for patients, but may not seem as important.
    How do we get everyone to participate in quality improvement work?

    • #2 by qualityhealthcareplease on July 4, 2014 - 10:27 PM

      It’s hard to get doctors involved in quality improvement since they have such a great financial incentive to spend their time elsewhere. From a political standpoint doctors can be a real roadblock to ANY change so asking for involvement is helpful. But, it really does not take very many doctors involved in QI to make a huge positive difference.

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