Saturday, February 11, 2012

Quality Improvement in Medicine and Medical Education

There are fads in medicine (e.g., “Vitamin E can prevent heart disease”, which we now know to NOT be the case), and then there are things that here to stay. The movement of quality improvement (QI) is definitely in the latter category. The importance of quality improvement in medicine cannot be overemphasized, yet there are some who question the utility of QI. There are others who have bought into why quality improvement is critical towards improving patient care. A new arena within medicine of “implementation science”, where putting guidelines into actual practice constitutes success, is emerging. This has even transcended maintenance of certification. Part 4 of the process involves doing a specific quality improvement project aimed at improving one’s performance with regards to patient care. All of the medical specialties in the ABMS have such a requirement. Quality improvement is also embedded into the CME world as well, with Performance Improvement CME, or PI-CME, coming of age as an important aspect of what physicians do. So how does a clinician go about doing quality improvement? My suggestion is to think about something that doesn’t go as smoothly as one would like (in the CME world, this is known as a “practice gap”, which drives why it is important for physicians to continually be educated). Whether it be ordering necessary tests in diabetic patients (e.g., urine for microalbumin, LDL cholesterol levels) or improving throughput in the office, quality improvement principles can guide an approach toward improving “something” (whatever the something may be). Within medical education, quality improvement curricula are now no longer innovative: they are REQUIRED. Residency programs are required to teach quality improvement to trainees, although the ideal way to teach it is not known. The literature in this arena is clearly growing, however, which is exciting, and it is common now at academic medical centers for residents to provide excellent ideas for improvement projects. So why is there push back to looking at improving how one practices? In other words, what can the organizations which lead the QI movement do to achieve front-line clinician buy-in to the importance of the science of improvement? After all, the ultimate outcome is improved patient care outcomes, and who would not support that?

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