he philosophy behind the Fund's Program on Health Care Quality Improvement and Efficiency is that change is most likely to occur when a problem is understood and publicly recognized, when appropriate incentives are put in place, and when stakeholders have the capacity to initiate and sustain change. Consistent with this philosophy, the program continues to fund projects aimed at: 1) providing reliable information about quality of care to the public and the health care industry; 2) making a business case for improving the quality of care; 3) improving coordination of care and teamwork among health care professionals; and 4) facilitating the exchange of information between physicians and patients.
In this past year, Fund staff published an influential article in
Health Affairs demonstrating that quality improvement principles and tools have not permeated the medical profession.
(1) Drawing on results of the Commonwealth Fund 2003 National Survey of Physicians and Quality of Care, Fund staff Anne-Marie Audet, M.D., Michelle Doty, Ph.D., Jamil Shamasdin, and Stephen Schoenbaum, M.D., reported that a majority of physicians are not engaged in quality improvement practices, are not routinely using data to assess their performance, and are reluctant to share quality-of-care measures with the public. According to the authors, the science of quality improvement has been, for the most part, "institutionalized" but not yet "professionalized." Accelerating physician participation in quality improvement efforts, they say, will require building the infrastructure to support quality and enhancing physicians' knowledge and skills.
To engage physicians in quality improvement, the program is cofunding a project with the American Board of Internal Medicine Foundation to identify physician practices that are successfully using performance data to improve quality. The initiative, "Putting Quality into Practice," will produce a compendium of best practices, to be accompanied by filmed interviews with a selected group of physicians. These resources will help explain physicians' actions and motivations, describe barriers they encounter and the solutions they have devised, and illustrate the value of their quality improvement activities.
