What is quality?


Category : Medical Rants

Last week, SGIM sponsored a Quality Summit. During this 1 day meeting we focused our discussions on performance measurement and how should adjust for multiple co-morbidities. As the President of SGIM, I organized this conference and greatly enjoyed the intellectual stimulation during the presentations and the discussions that followed.

However, as I have reflected on that conference I feel like the blind man examining an elephant. Which part of the elephant did we examine?

What are the attributes of high quality medical care? I am giving my opinion on this subject later this month at a conference and had to put my thoughts into Powerpoint slides. My current formulation has at least 4 explicit dimensions:

  • Diagnostic acumen
  • Patient interactions (Careful explanations; Motivating patients (behavior change or adherence); Understanding the patient’s motivation)
  • Management
  • Interactions (Understanding how drugs interact; Understanding how diseases interact)

We currently spend our energies focused on management and screening, because those dimensions are tractable for measurement. I worry that focusing our energies on measurement will detract from the other important characteristics of excellence. Afterall, physicians do know how to do well on the test. We all want excellent physician quality. We must be careful that we do not become enamored with what we can measure as an indicator of overall quality. Being a physician is much more complex than filling out check lists. Being a critic of current P4P does not mean that I am a critic of quality.

free viagra
buy viagra online
generic viagra
how does viagra work
cheap viagra
buy viagra
buy viagra online inurl
viagra 6 free samples
viagra online
viagra for women
viagra side effects
female viagra
natural viagra
online viagra
cheapest viagra prices
herbal viagra
alternative to viagra
buy generic viagra
purchase viagra online
free viagra without prescription
viagra attorneys
free viagra samples before buying
buy generic viagra cheap
viagra uk
generic viagra online
try viagra for free
generic viagra from india
fda approves viagra
free viagra sample
what is better viagra or levitra
discount generic viagra online
viagra cialis levitra
viagra dosage
viagra cheap
viagra on line
best price for viagra
free sample pack of viagra
viagra generic
viagra without prescription
discount viagra
gay viagra
mail order viagra
viagra inurl
generic viagra online paypal
generic viagra overnight
generic viagra online pharmacy
generic viagra uk
buy cheap viagra online uk
suppliers of viagra
how long does viagra last
viagra sex
generic viagra soft tabs
generic viagra 100mg
buy viagra onli
generic viagra online without prescription
viagra energy drink
cheapest uk supplier viagra
viagra cialis
generic viagra safe
viagra professional
viagra sales
viagra free trial pack
viagra lawyers
over the counter viagra
best price for generic viagra
viagra jokes
buying viagra
viagra samples
viagra sample
generic cialis
cheapest cialis
buy cialis online
buying generic cialis
cialis for order
what are the side effects of cialis
buy generic cialis
what is the generic name for cialis
cheap cialis
cialis online
buy cialis
cialis side effects
how long does cialis last
cialis forum
cialis lawyer ohio
cialis attorneys
cialis attorney columbus
cialis injury lawyer ohio
cialis injury attorney ohio
cialis injury lawyer columbus
prices cialis
cialis lawyers
viagra cialis levitra
cialis lawyer columbus
online generic cialis
daily cialis
cialis injury attorney columbus
cialis attorney ohio
cialis cost
cialis professional
cialis super active
how does cialis work
what does cialis look like
cialis drug
viagra cialis
cialis to buy new zealand
cialis without prescription
free cialis
cialis soft tabs
discount cialis
cialis generic
generic cialis from india
cheap cialis sale online
cialis daily
cialis reviews
cialis generico
how can i take cialis
cheap cialis si
cialis vs viagra
generic levitra
levitra attorneys
what is better viagra or levitra
viagra cialis levitra
levitra side effects
buy levitra
levitra online
levitra dangers
how does levitra work
levitra lawyers
what is the difference between levitra and viagra
levitra versus viagra
which works better viagra or levitra
buy levitra and overnight shipping
levitra vs viagra
canidan pharmacies levitra
how long does levitra last
viagra cialis levitra
levitra acheter
comprare levitra
levitra ohne rezept
levitra 20mg
levitra senza ricetta
cheapest generic levitra
levitra compra
cheap levitra
levitra overnight
levitra generika
levitra kaufen

Comments (4)

I would include some risk adjusted measure of successful outcomes vs complications, infections, even deaths if we are talking about surgical procedures.

Robert M. Pirsig discusses at length what “quality” means in Zen and the Art of Motorcycle Maintenance; it’s a good read that adds a philosophical view of quality that may benefit your examination of “quality.”

I just posted (here) on my experiences with a P4P discussion at a recent medical meeting. The whole issue of “quality” and how it is defined is my main point.

I posted a counter-rant Here

Post a comment