To achieve high-quality medical care, we must succeed at three main tasks. First, we must determine just what practices constitute high-quality care. This involves analyzing evidence of the effectiveness, risks, and costs of various medical practices, and designing standards that define appropriate practices. The second task involves monitoring existing practices to compare them against the accepted standards. The third involves changing the behavior of practitioners to ensure that the care actually delivered meet the standards. Failure at any of these tasks will threaten the quality of care people actually receive. This article examines our current ability to perform the first task. It examines the quality of evidence and the quality of analysis that supports some current standards of practice. It will argue that, for at least some important practices, the existing evidence is of such poor quality that it is virtually impossible to determine even what effect the practice has on patients, much less whether that effect is preferable to the outcomes that would have occurred with other options. Furthermore, whatever the quality of the existing evidence, our current ability to analyze that information is primitive. As a consequence of these two findings, we simply do not know the appropriate standard of care for some medical practices. The care that is currently being delivered might or might not be appropriate. The standards we use to evaluate actual practice may or may not be the corect ones. The article concludes that, to design truly effective quality assurance progams, we must do considerably more work to obtain better evidence about the health and economic effects of different options and to use that evidence in designing appropriate standards of practice. Accomplishing this will require not only specific actions but also a consolidation of leadership, the development of a common vision and set of principles, and coordination and compromises in executing those principles.
ASJC Scopus subject areas
- Health Policy