Continuous quality improvement and knowledge for improvement applied to asthma care

Area of Science:

• Healthcare Quality Improvement
• Medical Education Research
• Health Services Research

Background:

• Continuous quality improvement (CQI) in healthcare distinguishes between professional knowledge and knowledge for improvement.
• The
• bad apple
• theory often fails to adequately explain variations in patient care outcomes.

Purpose of the Study:

• To investigate the causes of variation in costs and outcomes for asthma patient care.
• To assess the impact of different care sites on patient costs and outcomes.
• To evaluate the role of traditional professional knowledge versus "knowledge for improvement" in healthcare quality.

Main Methods:

• Medical students on a primary care clerkship observed and reported on the cost and outcome of asthma patient care across over 20 sites.
• Students identified the primary factor influencing cost and outcome variation for their assigned patients.
• Analysis included frequency counts, correlation analysis, and one-way analysis of means/standard deviations for cost data.

Main Results:

• Disease severity and site of care were most frequently cited as causes of cost variation (18% each).
• Disease severity was the leading cause of outcome variation.
• No correlation was found between healthcare costs and patient outcomes; higher costs did not lead to better health.
• Analysis of care sites indicated most were within expected cost ranges, with one outlier site having minimal impact on overall costs.

Conclusions:

• Over half of the reported causes for asthma care variation lie outside traditional professional knowledge.
• Current health professions education predominantly focuses on professional knowledge.
• Achieving genuine healthcare improvement necessitates integrating "knowledge for improvement" with existing professional knowledge.