what is quality

Quality measurement – a delusion

April 26, 2009

Everyone wants to insure quality.  Quality is job #1.  Who can be against quality?  We should measure quality, report it, reward it, and publicize it. But what is quality medical care?  Can we measure it easily? Many argue that we can measure quality.  My friend and colleague, Bob Wachter, argues for quality measurement – On [...]

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How to insure quality

April 13, 2009

  I received a comment today on my quality rant. Even when the guidelines have retrospectively been shown to be flawed, where’s the evidence of patient harm? Did the harm outweigh the benefits? You should know better than to make an argument without these numbers. Sounds like a straw-man argument to me. If you’ll actually [...]

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Groopman on quality

April 12, 2009

  Regular readers know my opinion on P4P.  I have often expressed my concerns about calling something quality when in fact it only represents one of many dimensions of a complex concept called quality. Dr. Groopman and colleague have an outstanding editorial which makes the case once again – Why ‘Quality’ Care Is Dangerous These and [...]

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What is quality medical care?

February 9, 2009

  UnitedHealth and I.B.M. Test Health Care Plan UnitedHealth will try giving doctors more authority and money than usual in return for closely monitoring their patients’ progress, even when patients go to specialists or require hospitalization. The insurer will also move away from paying doctors solely on the basis of how many services they provide, [...]

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Quality improvement is a misnomer

November 30, 2008

  Readers know that I am obsessed with semantics.  I know that words are powerful.  Oft times words are labels.  Too often people use words to obfuscate meaning.  My hypothesis is that quality improvement is an obfuscating phrase. The key here is the definition of quality.  How does one measure quality?  Opinion leaders have made [...]

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More on diagnostic errors

June 11, 2008

  I have been writing about the importance of accurate diagnosis throughout the 6+ years of this blog’s existence.  I frequently opine that the quality movement has ignored diagnostic accuracy because it is not easily measured. Maggie Mahar tries to address this issue in two recent blog entries – The Silence Surrounding Diagnostic Errors; Part [...]

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db’s medrants 2007 considered – the year of quality

December 31, 2007

Allow me some time to consider my main messages over the last year. My blog has evolved significantly since starting in May 2002. Originally I focused on finding health related links. I would make some commentary, but rarely wrote essay style entries. Now I probably spend more time exploring ideas. This year I have focused [...]

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