Quality Improvement: Part 1 (Introduction)

In the past 40 years we have seen a consistent increase in the cost of healthcare. Currently, medical costs constitute approximately 18% of our annual GDP and totaled 3.5 Trillion Dollars in 2017 (CMS.gov).

This means that the average American is spending $10,739 per year on healthcare expenditures. However, despite this increased spending, compared to other industrialized nations the United States ranks amongst the worst in healthcare outcomes (Commonwealth Fund). This is particularly evident in efficiency and cost effectiveness where the United States is ranked 11th out of 11 countries studied. Over the past decade, this data has driven the need for clinicians to be more cognizant of how they provide care to their patients. Quality improvement (QI) initiatives have become an important metric to help drive these practice changes.

According to the U.S. Department of Health Resources and Human Services Administration, QI is defined as systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups. The important part of this definition is in the systemic approach and measurable outcomes. As the value of QI has become more apparent in the academic community, academic journals have established criteria for QI research that is on par with the rigor of basic/clinical science articles. Furthermore, QI has become increasingly important in academic programs where the degree of implementation used is a measurement in program rankings by US News and World Report. QI has also become an essential competency requirement for resident/fellow trainees by the Accreditation Council for Graduate Medical Education (ACGME). However, the importance does not end with training; maintenance of certification (MOC) part IV stipulates the need to participate in quality improvement throughout one’s career.

As medicine catches up with other industries in the utilization of data science to drive outcome measures, learning the concepts and applying the tools of QI will become essential to understanding large process changes within a hospital system.

In future articles we will discuss in greater detail the broad concepts of QI, including lean methodology, and demonstrate how to implement these concepts into your everyday practice. This will promote the practice of using objective data to drive practice changes and ensure that we as physicians continue to be leaders in high quality, efficient, cost-effective medicine.

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