QUALITY / TOOLS: INTERACTIVE (Q/TI)
(Links are For further information)
A presently hopeful, and increasingly popular, approach to quality
improvement is a version of CQI (Continuous Quality Improvement) that
has to some extent been pioneered in Utah. It is concerned with
improving practice
patterns: i.e. the ways particular conditions are diagnosed and
treated.
It is interactive in two ways. (1) It builds upon a continuing
discussion among a group of providers dealing with a particular
condition or process: e.g. the group of teams in a hospital or a region
removing cataracts. These discussions seek to understand why there is
variation in this treatment, to
identify and continually refine appropriate guidelines for the
treatment, and to continuously reduce the variation around these
guidelines. (2) It employs
a continuing monitoring of practice -- a continuous interaction between
the
group and data that reports actual practice. The purpose is to see
where variation
deserves to be reduced or where variation suggests a change or
refinement
of the guidelines.
Among the basic principles of the approach are: (1) The primary concern
is to improve the general standards and habits of practice rather than
to
identify and remove/correct incompetents. (2) The process is highly
decentralized and participatory. (3) It is a continuous process, not a
one-time correction. (4) Progress depends upon quick feedback with
reliable and respected data.
Success is aided by: cooperative relationships among practitioners;
good information systems, both clinical and administrative; and
encouraging incentives and leadership. Resources in Utah facilitating
this approach include:
HealthInsight, the peer review organization for
Nevada and Utah.
Dr. Brent James and others at Intermountain Health
Care.
The Medical Informatics programs at IHC and the
University of Utah.
The recent Institute of Medicine
(same link as above) studies of quality often reflect and encourage
this approach.
AHRQ (Agency for Healthcare Research
and
Quality, pronounced arc) has initiated an "online journal and forum on
patient
safety and health care quality", webmm.ahrq.gov,
that is interesting to generalists not only in itself but as a view
into
the work of the Morbidity and Mortality (M&M) conferences held
monthly
in most hospitals.