QUALITY / DESIGNS   (Q/D)

Approaches to improving quality include:

Enhancing resources:
  1. Research re new equipment, new and existing medications, and new processes to improve medical technology.
  2. Education of the health care workforce (physicians, etc.) and patients (and families and other care givers) to make skilled and appropriate use of technology.
  3. Distribution of (expenditures for) technology and workforce to enhance access to the technology and workforce constituting quality care

Improving processes that apply existing technologies:
  1. Law has been a frequent and major approach to quality of health and health care. (for further information) Sara Rosenbaum's JAMA article of March 26, 2003 assesses the evolution of this approach, as is summarized in the article's abstract:

    The evolution of US law has had an enormous influence on medicine as a profession, and much of this legal evolution can be attributed to changes in the science and practice of medicine. This changing legal framework and its intersection with medicine has many facets. Three of the most important facets concern the evolution of the no duty-to-treat principle and the role modern health care financing and civil rights law is altering this rule, the manner in which advances in medicine led courts and legislatures to change the standards against which professional medical liability is measured, and the basic loss of highly preferential treatment under US laws aimed at preventing anticompetitive conduct by businesses. However, despite the impact on the profession of an evolving legal system, concern over the integrity of medical professionalism continues to significantly influence both laws and lawmakers, including legislatures, regulatory agencies, and the courts.

    Legal determinations and penalties for malpractice have been presumed to be incentives for quality care and means to compensate victims of poor care. But studies raise serious questions about the effectiveness of such (for further information) tort law to fairly meet either of these objectives.

  2. (for further information) Institute of Medicine reports re medical errors focus upon improving processes, as opposed to attributing guilt, with particular attention on the processes of health care practitiooners and providers.

  3. There are also a growing number of improved efforts to enable better management of conditions by patients and their families and other lay caregivers. An example is (for further information) guidance concerning end-of-life care.
Improving health:
  1. Changing the level and allocation of  resources applied to (for further information) prevention and to treatments. Care must be taken to avoid (for further information) overselling prevention on the basis of cost savings, and to recognize that prevention may be worth increased costs as an improvement in quality of life. A second caution is that (for further information) health promotion efforts may result in damages such as stigmatization, uninsurability, and employment discrimination.
  2. Adjusting the relative emphasis upon correction and support for medical conditions. One criticism has been of "half-way technologies" that only partially deal with health problems -- the argument is that more attention should go to developing technologies that either prevent the problem (e.g. seat belts) or solve a health problem (e.g. an inexpensive and easily administered drug controlling a peanut allergy -- still a part-way technology, but could be most of the way). On the other hand, there are advocates for more support and less treatment for chronic conditions that can not be resolved by exiting technologies. Advocacy groups are concerned that such patients are too often subjected to experimentation rather than given support (e.g. for activities of daily living) that would clearly improve their quality of life and that of their caregivers.