Improving QI

Sean Berenholtz and colleagues have a nice commentary/review piece in this month’s Joint Commission Journal on Quality and Patient Safety that touches again on the tension between quality improvement and the science of healthcare epidemiology. They start with an anecdote about the presentation of a QI project at a patient safety meeting, during which many important potential biases and limitations were not mentioned. To quote directly from the piece:

"When an audience member questioned the validity of the results, the presenter clarified that the data were for “quality improvement” not “research,” implying, as stated earlier, that QI projects are exempt from the rigorous methodological standards required of other research projects. In our experience, such views are widely promulgated among QI practitioners."

The rest of the piece reviews basic concepts in study design and interpretation, and includes a useful checklist for evaluating QI projects.

The piece also does a good job of succinctly arguing the importance of rigorous standards for QI, and the potential unintended consequences of accepting and disseminating practices that are based upon inaccurate data and/or flawed study designs.

"Overestimates of the extent to which harm is preventable may anchor policymakers’ beliefs and create potentially unjust and unwise policies."

True, that.

Mike's recent post on QI vs. Healthcare Epidemiology

Joint Commission Journal article (subscription required for access)