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This journal scan is based on a hand search of the following seven journals focusing on health services research and policy for 1999 and up to March 2000: Journal of Health Services Research and Policy, Milbank Quarterly, Medical Care, Health Services Research, Health Affairs, Health Policy, and Medical Care Research and Review. A special issue of the Milbank Quarterly dedicated to the issue of quality is also included. This special issue contains seven papers and several commentaries which are based on an Institute of Medicine (USA) National Roundtable conference to discuss strategies for improving the quality of health care. The summaries below were written by the scanner, drawing on the published abstract where appropriate.

Schuster MA, McGlynn EA, Brook RH. How good is the quality of health care in the United States? Milbank Quarterly 1998;76(4):517–63.

A systematic review of the literature since 1993 which reported studies on the quality of care (other than in single hospitals or clinics) in the USA. The authors found surprisingly little systematic knowledge available and, what there was, highlighted large gaps between the care people should receive and the care actually received (both overuse and underuse). Summary tables are provided for each study.

Chassin MR. Is health care ready for six sigma quality? Milbank Quarterly 1998;76(4):565–91.

This paper explores the underlying causes of quality problems in health care, discusses some of the main obstacles to improvement, and suggests the components of effective strategies to increase the pace of quality improvement. “Six sigma quality” refers to the strategy devised by Motorola which sets the tolerance limits for defective products at six standard deviations from the mean (so that less than 3.4 defects occur per million produced).

Shortell SM, Benet CL, Byck GR. Assessing the impact of continuous quality improvement on clinical practice: what will it take to accelerate progress. Milbank Quarterly 1998;76(4):593–624.

A systematic review of research between 1991 and 1997 on the impact of the clinical application of CQI. 42 single site and 13 multisite studies were identified. Most of these were “before and after” studies so it is difficult to attribute reported change to the introduction of …

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