Readers know that I am obsessed with semantics. I know that words are powerful. Oft times words are labels. Too often people use words to obfuscate meaning. My hypothesis is that quality improvement is an obfuscating phrase.
The key here is the definition of quality. How does one measure quality? Opinion leaders have made the leap from performance measurement to quality. We should work through the logic.
Researchers and “quality” gurus take guidelines and transform them into performance measures. For example, the percentage of post myocardial infarction patients who are taking beta blockers or the percentage of type II diabetics with a HgbA1c < 7. We have all read many performance measures.
These “quality experts” take well documented research findings and make the logical assumption that providing this “evidence based” care defines quality care. For example, we know that lower HgbA1c correlates with better outcomes. Therefore they assume that striving to lower the HgbA1c (and succeeding) defines higher quality care.
I submit that they need to study the philosophy of logic. They are missing an important step.
The problem comes from the studies themselves. Patients in studies are often much different from other patients. As patients suffer more diseases, interpreting a performance measure on one disease must become more complex.
“Quality improvement” implies that patients will have better outcomes. Yet, few studies exist that show that improving performance measures really improves outcomes.
This model makes the unsubstantiated assumption that improving performance measures equates with improved outcomes, and thus we can label our efforts as quality improvement.
We should be precise with our semantics. We should call these programs performance measure improvement. If we call them by the proper term, we would have much higher level discussions of this entire movement. The movement, while well meaning, is increasing resource use without proving that we also are improving outcomes. Perhaps we are; perhaps we are not. We should not call these efforts quality improvement until and unless we have clear outcome data in standard patients.
