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The Science and Practice of Quality Improvement: Where Do We Stand?

The Science and Practice of Quality Improvement: Where Do We Stand?. AcademyHealth June 10, 2008 Jeff Alexander, Ph.D. Department of Health Management and Policy University of Michigan School of Public Health. Background.

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The Science and Practice of Quality Improvement: Where Do We Stand?

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  1. The Science and Practice of Quality Improvement: Where Do We Stand? AcademyHealth June 10, 2008 Jeff Alexander, Ph.D. Department of Health Management and Policy University of Michigan School of Public Health

  2. Background • IOM’s report on the state of healthcare quality (Institute of Medicine, 2000) and calls for system redesign (Institute of Medicine, 2001) have elevated the importance and number of quality improvement (QI) studies. • What does this research say about effectiveness of QI “interventions”? • How can such research be improved?

  3. Average organization sample size by organization type

  4. Relationships with quality by research design 1

  5. Relationship with quality by study design

  6. State of the Art – QI Research • Single organizational samples • Opportunistic not systematic • Short duration studies • No replication of studies • No explicit consideration of context • No explicit consideration of implementation

  7. Bottom line: We have only limited understanding of what works, when it works, or where it works

  8. THE LINEAR MODEL of QI Clinical Trial (Efficacy) Basic Research Treatment Development Effectiveness Trial Treatment Deployment

  9. Problems with the Linear Model of QI • Little on causal pathways & nested interconnected structures and activities • Little influence of OT & OB in QI studies • RCT thinking: control context away

  10. RCTs as the Gold Standard? • Great for testing efficacy of molar interventions • Not so great for assessing: • Process related phenomena • Complex interactions among program components • Contextual effects • implementation

  11. Capacity Building for QI Implementation Research • Data • Funding • Multi-disciplinary teams • Make implementation part of the intervention • Bring in users of intervention/innovation • Long term studies • Basic research on implementation

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