I’m not the only one who has questioned the real impact of the quality movement in healthcare. Robert Brook, MD, ScD of RAND Health has written about similar concerns.
In an article in JAMA from last year, he states “[m]ore than 40 years later it is unclear what the quality movement has accomplished. Very little is known about how many dollars are invested to improve quality of care nationally … and there is insufficient evidence about whether or how the quality of care has actually improved.”
He shares another concern with me that “… it is the rare article that actually includes measurement of cost or expenditures in a study that attempts to improve quality.”
Quality improvement interventions should be thought of as healthcare interventions like tests or treatments. An initial investment must be made, usually in the form of labor and process improvements, that may or may not lead to actual improvements in health. This means a QI intervention will also have a cost-effectiveness reality.
The pending analyses of the Quality and Outcomes Framework in the U.K. will give us all general insights as to the cost-effectiveness of some outpatient QI interventions. We need more data on the effectiveness and cost-effectiveness of QI efforts on this side of the pond.
Once you start providing this “quality” the patients expect to get this test or lab or visit to a specialist every year. I am very concerned and my patients feel that I don’t have their best interests at heart if I don’t order all of the labs and test that they want or think they need.