Tuesday, October 26, 2010

Quality, safety, and value

There is an interesting commentary in JAMA this week. The money quote:

“So more than 40 years after the birth of the quality improvement movement, there is still not much known about what has been accomplished.”
The author, Robert Brook, argues for embracing the business case for quality, and for developing a new “epidemiology of value”,

“…which contains both measurement of cost and quality, and is applicable to both the developed and developing world. The results of this work would help to distinguish between a level of quality that is a good value and the best available quality that may produce small improvements in health at enormous cost.”
Eli, as our house economist, has a better grasp of what it takes to build a business case for quality…I should let him take it from here…

1 comment:

  1. This is a fantastic commentary. It's as if for one bright shiny moment, the medical field might embrace that we live in a world of limited resources and that we have to address the cost/value question.

    In writing the forward to the 1993 US Panel on Cost-effectiveness in Health and Medicine, J. Michael McGinnis writes: "Two realities provide compelling context to health policy decisions in a world preparing for the 21st century: The availability of health-related interventions in the marketplace exceeds by a considerable margin our societal ability to afford them; and our current decision rules are inadequate to guide choices toward those interventions that are likely to yield the most benefit for the population."

    Unfortunately, at least at this early point in the 21st century, many in the US have gone to comparative effectiveness as a paradigm for fear of seeing to ration care. The reality is that there must be a trade-off between cost and benefit; no matter what stage of denial our government and politicians are stuck in, at some point we must use cost-effectiveness to reduce costs AND increase quality. I'm all for the business case for quality, but it needs to be anchored in the solid methodological foundation of cost-effectiveness research. Perhaps that is what Robert Brook meant when he said we should be "developing an epidemiology of value." I hope so, since the field of cost-effectiveness research already exists.