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- Clinical Practice Guidelines
- Implementation Science
- Evidence-based Medicine
- Healthcare Quality Improvement
- Quality Improvement Methodologies
It is clear that US health care delivery provides unprecedented health benefits to those who seek its services. It is equally clear that care delivery, and the benefits that it achieves, could be much better. Advances in biomedical research and the application of health care delivery science described in the accompanying supplement have resulted in striking improvements in survival for patients with cystic fibrosis (CF) in the USA. Recent successes in improving CF-related care delivery provide a model to broadly improve health care delivery and patient outcomes on a much wider scale.
Current care delivery falls short of its theoretic potential
About 50 years ago clinical investigators began to apply well-established research measurement tools to health care delivery performance. They discovered massive variation. For example, Wennberg et al documented large differences in hospitalisation rates for comparable patients across geographic referral areas.1 ,2 Others showed high levels of practice variation among physicians treating similar patients within single hospitals.3 Chassin et al documented high rates of clinically inappropriate care (overuse), where the risk inherent in treatment outweighed any potential clinical benefit to the patient.4 A report from the Institute of Medicine conservatively estimated that as many as 98 000 hospitalised patients die each year from preventable injuries associated with their treatment (misuse).5 Subsequent studies found that the true preventable care-associated death rate is much higher.6 McGlynn et al showed that, for a long list of non-controversial, widely-accepted, clearly beneficial clinical interventions based on compelling evidence from randomised controlled trials (RCTs), the care delivery system performs correctly only 54.9% of the time for adults7 and 46% of the time for children (underuse).8
A common theme emerged as investigators tracked possible causes of care delivery variation, care-associated patient injuries, and widespread inability to reliably execute routine care delivery tasks. The healing professions adopted the scientific method as …
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