Fifty percent of quality improvement studies fail to change medical practices

Over the last two decades, nearly half of all initiatives that review and provide feedback to clinicians on healthcare practices show little to no impact on quality of care, according to a new study by Women's College Hospital's Dr. Noah Ivers.

The study, published in the Journal of General Internal Medicine, found only 28 per cent of all studies showed an improvement of at least 10 per cent in quality of care over a 25-year period.

"Research shows there is a gap between recommended practices and the care actually receive," said Dr. Noah Ivers, a family physician at Women's College Hospital and lead author of the study. "While we have a number of studies showing that providing to can act as a foundation for improving quality of care if done properly, we found, in most cases, quality improvement efforts are haphazardly implemented, reinventing the wheel rather than learning from what we already know."

In the study, researchers examined 62 studies in the scientific literature and found feedback on was most effective when:

  • it is delivered by a respected colleague
  • it is repeated multiple times
  • it includes specific goals and action plans, and
  • it focuses on a problem where there was a larger scope for improvement.

When efforts to improve quality of care do not build on lessons learned from previous research, opportunities are wasted to improve outcomes for patients, the researchers said. Just as best evidence should be used to decide which treatment is the right choice for a certain problem, a scientific approach should be taken when figuring out ways to ensure that patients receive the right treatment every time, they add.

"New scientific studies that have tried to get clinicians to more consistently provide the right care for the right patients by providing them with feedback reports of their past performance have contributed little new knowledge on how to best do this so that it results in better outcomes for patients," Dr. Ivers noted. "While we know from previous research that providing clinicians with a specific action plan for improvement is essential for providing better care for patients, feedback initiatives rarely include plans aimed at changing the behavior of healthcare professionals."

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