The Tension between Needing to Improve Care and Knowing How to Do It
New England Journal of MedicinePublished 8 August 2007
Andrew D. Auerbach, C. Seth Landefeld, Kaveh G Shojania
Citations413
SJR quartileQ1
SJR score19.08
SNIP13.47
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Quality-improvement initiatives should not be widely disseminated unless studies have demonstrated that they are safe and effective, the authors argue.
Abstract
The authors argue that interventions to improve health care quality should be held to the same standards that we apply to medical treatments. They believe quality-improvement initiatives should not be widely disseminated unless studies have demonstrated that they are safe and effective.
Keywords
Health ProfessionsEconomics, Econometrics and Finance
National Academies Press eBooksTo Err Is Human
14,096 Citations2000Institute of Medicine
A process for the preparation of prostaglandins which are known pharmaceutically active compounds and then R alpha , R omega -cyclopentenoids is described.
Milbank QuarterlyEvaluating the Quality of Medical Care
5,939 Citations2005Avedis Donabedian
This paper deals almost exclusively with the evaluation of the medical care process at the level of physician-patient interaction and excludes processes primarily related to the effective delivery of medical care at the community level.
The Milbank Memorial Fund QuarterlyEvaluating the Quality of Medical Care
4,319 Citations1966Avedis Donabedian
New England Journal of MedicineRandomized, Controlled Trials, Observational Studies, and the Hierarchy of Research Designs
3,474 Citations2000John Concato, Nirav R. Shah +1 more
The results of well-designed observational studies (with either a cohort or a case-control design) do not systematically overestimate the magnitude of the effects of treatment as compared with those in randomized, controlled trials on the same topic.
American Sociological ReviewThe Unanticipated Consequences of Purposive Social Action
2,461 Citations1936Robert Κ. Merton
New England Journal of MedicineA Comparison of Observational Studies and Randomized, Controlled Trials
2,352 Citations2000Kjell Benson, Arthur J. Hartz
Little evidence is found that estimates of treatment effects in observational studies reported after 1984 are either consistently larger than or qualitatively different from those obtained in randomized, controlled trials.
JAMARole of Computerized Physician Order Entry Systems in Facilitating Medication Errors
2,116 Citations2005Ross Koppel
The LancetIntroduction of the medical emergency team (MET) system: a cluster-randomised controlled trial
1,299 Citations2005‡
The MET system greatly increases emergency team calling, but does not substantially affect the incidence of cardiac arrest, unplanned ICU admissions, or unexpected death.
JAMAThe Urgent Need to Improve Health Care Quality<SUBTITLE>Institute of Medicine National Roundtable on Health Care Quality</SUBTITLE>
1,249 Citations1998Mark R. Chassin
BMJParachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials
1,150 Citations2003Gordon C. S. Smith, Jill P Pell
It is thought that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.
PEDIATRICSUnexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System
1,150 Citations2005Yong Han, Joseph A. Carcillo +6 more
New England Journal of MedicineStrategies for Reducing the Door-to-Balloon Time in Acute Myocardial Infarction
836 Citations2006Elizabeth H. Bradley, Jeph Herrin +12 more
Several specific hospital strategies are associated with a significant reduction in the door-to-balloon time in the management of myocardial infarction with ST-segment elevation.
BMJEffects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study
810 Citations2002Michael Buist
In clinically unstable inpatients early intervention by a medical emergency team significantly reduces the incidence of and mortality from unexpected cardiac arrest in hospital.
Archives of Internal MedicineRole of Pharmacist Counseling in Preventing Adverse Drug Events After Hospitalization
788 Citations2006Jeffrey L. Schnipper, Jennifer L. Kirwin +9 more
Pharmacist medication review, patient counseling, and telephone follow-up were associated with a lower rate of preventable ADEs 30 days after hospital discharge, and medication discrepancies before and after discharge were common targets of intervention.
JAMAThe 100 000 Lives Campaign
691 Citations2006Donald M. Berwick, David R. Calkins +2 more
The 100 000 Lives Campaign is a national initiative with a goal of saving 100 000 lives among patients in hospitals through improvements in the safety and effectiveness of health care, and proposes that US hospitals implement as many as possible of 6 highly feasible interventions.
New England Journal of MedicineFatigue among Clinicians and the Safety of Patients
685 Citations2002David M. Gaba, Steven K. Howard
The authors argue that reform is needed because the long work hours of clinicians adversely affect the quality of health care and current policies regulating residents' hours of work and options for new regulations governing residency shifts.
Health AffairsEvidence-Based Quality Improvement: The State Of The Science
680 Citations2005Kaveh G Shojania, Jeremy Grimshaw
This work reviews problems with current approaches to QI research, outlines the steps required to make QI efforts based as much on evidence as the practices they seek to implement, and reviews the current state of quality improvement research.
PubMedEffects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis.
667 Citations2006Kaveh G Shojania, Sumant R Ranji +5 more
Most QI strategies produced small to modest improvements in glycemic control, but team changes and case management showed more robust improvements, especially for interventions in which case managers could adjust medications without awaiting physician approval.
BMJWhen are randomised trials unnecessary? Picking signal from noise
571 Citations2007Paul Glasziou, Iain Chalmers +2 more
A list of historical examples of dramatic effects and the features of convincing inferences about treatment effects from sources other than randomised trials are identified, which may help to reduce controversy about evidence for treatments whose effects are so dramatic that randomised Trials are unnecessary.
JAMASafety of Patients Isolated for Infection Control
570 Citations2003Henry T. Stelfox
Compared with controls, patients isolated for infection control precautions experience more preventable adverse events, express greater dissatisfaction with their treatment, and have less documented care.
Critical Care MedicineProspective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates*
511 Citations2004Rinaldo Bellomo, Donna Goldsmith +7 more
The introduction of an intensive care unit-based medical emergency team in a teaching hospital was associated with a reduced incidence of postoperative adverse outcomes, postoperative mortality rate, and mean duration of hospital stay.
JAMASleep Deprivation and Clinical Performance
406 Citations2002Matthew B. Weinger
This review focuses on the consequences of sleep loss both in controlled laboratory environments and in clinical studies involving medical personnel, and the potential adverse impact of reduced work schedules on the economics of health care, on continuity of care, and on quality of care.
Journal of the American Medical Informatics AssociationImproving Patient Safety by Identifying Side Effects from Introducing Bar Coding in Medication Administration
376 Citations2002Emily S. Patterson, Richard I. Cook +1 more
Five negative side effects after the implementation of bar code medication administration (BCMA), a technology designed to reduce adverse drug events (ADEs), are identified that might create new paths to ADEs.
BMJ Quality & SafetyUse of medical emergency team responses to reduce hospital cardiopulmonary arrests
357 Citations2004Michael A. DeVita
The Medical Journal of AustraliaRates of in‐hospital arrests, deaths and intensive care admissions: the effect of a medical emergency team
354 Citations2000Peter Bristow, Ken M HIiiman +6 more
To evaluate the effectiveness of a medical emergency team (MET) in reducing the rates of selected adverse events, a large number of patients are referred to the hospital’s emergency department.
BMJ Quality & SafetyUse of medical emergency team responses to reduce hospital cardiopulmonary arrests
344 Citations2004Michael A. DeVita
Increased use of MET may be associated with fewer cardiopulmonary arrests after there was a rapid and sustained increase in the use ofMET.
Obstetrics and GynecologyEffects of Teamwork Training on Adverse Outcomes and Process of Care in Labor and Delivery
322 Citations2007Peter E. Nielsen, Marlene Goldman +13 more
The Adverse Outcome Index could be an important tool for comparing obstetric outcomes within and between institutions to help guide quality improvement.
New England Journal of MedicineImproving the Management of Chronic Disease at Community Health Centers
280 Citations2007Bruce E. Landon, LeRoi S. Hicks +5 more
Overall, the intervention centers had considerably greater improvement than the external and internal control centers in the composite measures of quality for the care of patients with asthma and diabetes, but not for those with hypertension.
Annals of Internal MedicineCreating the Evidence Base for Quality Improvement Collaboratives
273 Citations2004Brian S. Mittman
The quality improvement collaborative (QIC) examined by Landon and colleagues in this issue is arguably the health care delivery industry's most important response to quality and safety gaps; it represents substantial investments of time, effort, and funding.
JAMAThe Impact of a Regulation Restricting Medical House Staff Working Hours on the Quality of Patient Care
235 Citations1993Christine Lainé
It is suggested that restricted house staff working hours were associated with delayed test ordering by house staff and increased in-hospital complications, which resulted in potentially deleterious effects on the quality of care.
Annals of Internal MedicineSystematic Review: Effects of Resident Work Hours on Patient Safety
224 Citations2004Kathlyn E. Fletcher, Steven Q. Davis +4 more
A systematic review of the literature examining the relationship between limiting resident work hours and patient safety will help inform policymakers and guide policymakers, program directors, and others who are involved in educating residents.
JAMASafe but Sound
209 Citations2002Kaveh G Shojania, Bradford W Duncan +2 more
Making Health Care Safer: A Critical Analysis of Patient Safety Practices contains the complete results of a collaborative effort to develop a compendium of evidence-based patient safety practices, a resource summarizing the literature supporting practices relevant to improving patient safety.
New England Journal of MedicineAccidental Deaths, Saved Lives, and Improved Quality
198 Citations2005Troyen A. Brennan, Atul A. Gawande +2 more
The authors argue that despite the success of the patient-safety movement in attracting the attention of the public and the medical profession, the Institute of Medicine's goal of reducing deaths from medical errors by 50 percent has not been achieved.
JAMATracking Progress in Patient Safety
187 Citations2006Peter J. Pronovost, Marlene R. Miller +1 more
Annals of Internal MedicineChanges in Hospital Mortality Associated with Residency Work-Hour Regulations
175 Citations2007Kanaka Shetty, Jayanta Bhattacharya
Limiting residents' work hours was associated with lower in-hospital mortality rates for medical patients in teaching hospitals, and this finding suggested that duty-hours caps improve patient outcomes, but the sample size was too small to show effects on mortality.
Annals of Internal MedicineEffects of a Quality Improvement Collaborative on the Outcome of Care of Patients with HIV Infection: The EQHIV Study
167 Citations2004Bruce E. Landon, Ira B. Wilson +6 more
This controlled study evaluated an HIV care Breakthrough Series program that emphasized provider teams, sessions on quality improvement theory and techniques, and report backs about implementing quality improvement, with no important differences in quality of care between the 44 intervention clinics and the 25 control clinics.
JAMARapid Response Teams—Walk, Don't Run
153 Citations2006Bradford D. Winters, Julius Pham +1 more
In this commentary, the evidence supporting RRT programs, the reasons they have been so broadly implemented, and the potential risks of doing so are reviewed and suggestions for future directions are offered.
BMJ Quality & SafetyBroadening the view of evidence-based medicine
151 Citations2005Donald M. Berwick
The Joint Commission Journal on Quality and Patient SafetyThe 100,000 Lives Campaign: A Scientific and Policy Review
128 Citations2006Robert M. Wachter, Peter J. Pronovost
Although the 100,000 Lives Campaign succeeded in catalyzing efforts to improve safety and quality in American hospitals, the promotion of rapid response teams as a national standard is problematic, and methodologic concerns regarding the "lives saved" calculations make it difficult to interpret the campaign's true accomplishments.
PubMedSelection bias and the perils of benchmarking.
113 Citations2005Jerker Denrell
To discover what makes a business successful, managers should look at both successes and failures, because if they do, they will overvalue risky business practices and not be able to tell if their current good fortune stems from smart business practices or if they are actually coasting on past accomplishments or good luck.
Annals of Internal MedicineChanges in Outcomes for Internal Medicine Inpatients after Work-Hour Regulations
93 Citations2007Leora I. Horwitz, Mikhail Kosiborod +2 more
This study compared changes in the rates of 7 clinical measures over a 2-year period for patients discharged from a teaching service that followed the ACGME work-hour rules to changes for patients discharge from a nonteaching hospitalist service, a retrospective cohort study at YaleNew Haven Hospital.
New England Journal of MedicineOn Washing Hands
62 Citations2004Atul A. Gawande
One afternoon last December, I took a tour of my hospital with Deborah Yokoe, an infectious-disease specialist, and Susan Marino, a medical technologist by training, and their full-time job is to stop the spread of infection in the hospital.
Journal of General Internal MedicineResidency work-hours reform
39 Citations2005Teryl K. Nuckols, José J. Escarce
This study sought to estimate the reform’s net cost in 2001 dollars, and to determine the reduction in preventable adverse events needed to make reform cost neutral from teaching hospital and societal perspectives.
JAMAThe impact of a regulation restricting medical house staff working hours on the quality of patient care
39 Citations1993C. Laine
Canadian Medical Association JournalImproving patient safety: moving beyond the "hype" of medical errors
30 Citations2005Alan J. Forster
The Medical Journal of AustraliaThe medical emergency team, evidence‐based medicine and ethics
30 Citations2003Ross Kerridge, W Peter Saul
It is proposed that decisions about changes in healthcare should consider scientific rationality, clinical reasonableness and resource implications, as well as evidence and ethical implications.
Annals of Internal MedicineHippocrates Affirmed? Limiting Residents' Work Hours Does No Harm to Patients
11 Citations2007Lee Goldman, Nicholas H. Fiebach
The question of benefit versus risk remained: Did the ACGME work-hour rules violate the Hippocratic principle of doing no harm?
