Measuring Quality of Care

McGlynn and Adams [1] repeat a point frequently made by the CLAHRC WM Director – before using outcomes to judge the quality of care, first model plausible effects.[2] [3] Only a small fraction of an outcome may be amenable to improved care.

The rate of hospital deaths in the UK is about 3%. Allowing a generous 20% of those to be preventable sets an upper headroom for improvement of 0.6%. So don’t expect quality of care to show up in mortality statistics. Or, to take another example, about 1% of hospital patients suffer a preventable medication related adverse event.[4] So don’t expect improved medicine management to show up in quality of life scores among the hospital population.

— Richard Lilford, CLAHRC WM Director

References:

  1. McGlynn EA, Adams JL. What makes a good quality measure? JAMA. 2014; 312(15): 1517-8.
  2. Yao GL, Novielli N, Manaseki-Holland S,Chen YF, van der Klink M, Barach P, Chilton PJ, Lilford RJ. Evaluation of a predevelopment service delivery intervention: an application to improve clinical handovers. BMJ Qual Saf. 2012; 21(s1): i29-38.
  3. Girling AJ, Hofer TP, Wu J, Chilton PJ, Nicholl JP, Mohammed MA, Lilford RJ. Case-mix adjusted hospital mortality is a poor proxy for preventable mortality: a modelling study. BMJ Quality & Safety. 2012; 21: 1052-6.
  4. de Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA. The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care. 2008; 17(3): 216-23.
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