Quality Matters Archive

Quality Matters reported on emerging models and trends in health care delivery reform and interviews with leaders in the field. Please read its successor, Transforming Care.

  • July/August 2008 Issue
In Focus: Pursuing Perfection Safely

Health care system performance can only improve with more robust measurement of quality improvement strategies designed to enhance patient safety, quality of care, and health outcomes. But, the federal government's action against a large, multi-site quality improvement project in Michigan last year has left many clinicians pursuing such improvements uncertain as to whether their projects are subject to the regulations for the protection of human research subjects.

Case Study: Is It Quality Improvement or Research? The Experiences of Intermountain Healthcare and Children's Hospital Boston

Case studies of two leading health care organizations show that they share a common perspective of quality improvement (QI) as integral to excellence in clinical practice and, therefore, subject to the same ethical obligation to deliver the best possible care to patients. Research on human subjects, in contrast, requires independent ethical oversight because of the potential conflicts between researchers' and patients' interests. Both organizations recognize that the decision to publish results or to use a particular analytic method alone does not distinguish QI from research. Moreover, in some cases QI can take on attributes of research, thus eliciting the need for prospective ethical oversight.

Recent Publications of Note
Selected articles on quality improvement from a number of journals, including the American Journal of Medicine, Annals of Internal Medicine, Archives of Pediatric and Adolescent Medicine, BMJ, Health Affairs, Health Services Research, International Journal for Quality in Health Care, Joint Commission Journal on Quality and Safety, Journal of the American Medical Association, Journal of General Internal Medicine, Journal of Patient Safety, Journal of Safety and Quality in Health Care, Medical Care, The Milbank Quarterly, The New England Journal of Medicine, and Pediatrics. The articles are nominated by Editorial Advisory Board members from a preselected list.

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