AHRQ Summary of Quality Improvement Method Reviews

Everyone wants better quality in health care.  And experts have lots of ideas on how to get better quality.  Do these ideas really work, especially in routine day-to-day medical practice?  The Agency for Healthcare Research and Quality has sponsored a series of meta-reviews on the research findings related to the most popular approaches to improving quality and now it issues a summary of those reports, which reflects the state of the science.    (AHRQ Report)   The quality “innovations” many of which are also the subject of public and private payer demonstrations, include bundled payments, the patient-centered medical home, quality improvement to address health disparities, medication adherence interventions, public reporting on quality measures, palliative care for advanced illness, quality improvement for people with disabilities and prevention of health care associated infections.

We have reported on several of the actual meta-reviews before and the summary confirms what we have surmised:  the research evidence is weak for beneficial effects of these quality initiatives.  This doesn’t mean that they aren’t effective, just that there isn’t really solid research that demonstrates that they are.  And we should ask ourselves if it makes sense to chase after a bunch of quality improvement programs that haven’t yet been shown to be effective.  Here is a quick summary of all that can really be said, based on research:  we don’t know what bundled payments do to quality; reducing out-of-pocket expenses might improve medication adherence (doh!); public reporting might create slight improvements in quality; some palliative care interventions improved patient and caregiver satisfaction and some interventions, if consistently applied, might reduce health care related infections.  The biggest takeaway:  more research is needed!!