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Quality improvement reports
Can the sum of projects end up in a program? The strategies that shape quality of care research
  1. Vahé A Kazandjian
  1. Dr Vahé A Kazandjian is the President of the Center for Performance Sciences, a global outcomes research organization, and A/Associate Professor, the Johns Hopkins Bloomberg School of Hygiene and Public Health, Baltimore, Maryland. He is the original architect of and is responsible for the Maryland Quality Indicator Project (QIP), the continuous performance improvement program used worldwide over the last 18 years by more than 2000 healthcare organizations. In the UK alone, over 125 hospitals from the NHS and the private sector have participated in the international component of the QIP since 1992.
  1. Correspondence to:
 Dr V A Kazandjian, Center for Performance Sciences, 6820 Deerpath Road, Elkridge, Maryland 21075–6234, USA;

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Quality improvement projects need to become ongoing sustainable programs if they are to alter culture, mind set, and perceived responsibilities in the practice of medicine.

Quality improvement (QI) projects are now an integral part of the strategy of healthcare systems towards accountability. While the immediate audience of the outcomes of such projects is internal to the care providing organization, accountability to external audiences (communities, government, payers, business coalitions) is increasingly demanded.1 Indeed, while in the past decade outcomes research was primarily the domain of healthcare professionals, now it seems the cornerstone of any accountability strategy. In the US such strategies are translated into “report cards”, in the UK to “league tables”, and elsewhere to “hospital ranking reports”. Even when the methods of analysis have not changed—variation, observed to expected ratios, statistically significant differences in utilization or outcomes rates—the landscape has been expanded to encompass numerous groups asking for accountability.2

To achieve responsiveness to various audiences, QI projects should measure temporal trends in performance, link outcomes to processes, and ascertain the extent of organizational readiness for promoting higher quality and safer systems of delivery. Epidemiological methods of measurement and analysis, specially based on rates, are necessary for a successful QI …

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