Advancing Quality Improvement Research Challenges and Opportunities: Workshop Summary (2007) / Chapter Skim
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3 Barriers to Quality Improvement and Quality Improvement Research
3 Barriers to Quality Improvement and Quality Improvement Research
Pages 27-36
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From page 27... ...
The question that must be raised, Davidoff commented, is this: Why has the evidence taken so long to develop? There is very little data available to guide the development of quality improvement research, of health sciences research, and of medicine in general, stated Harold Pincus of Columbia University and New York-Presbyterian Hospital.
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From page 28... ...
For example, the practice of health care policy is local, while the policy of health care is not, Batalden added. The local uptake of health care policies, thus, must be considered when working to improve care.
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From page 29... ...
RESOURCE BARRIERS Limited data exist about the resources allocated to health care quality improvement. According to the Coalition for Health Services Research, an estimated $1.5 billion of federal funding was spent on health services research in fiscal year 2006 (Coalition for Health Services Research, 2006)
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From page 30... ...
A related issue, Pincus said, is stakeholders' lack of motivation to build the infrastructure that is needed to attract health services researchers. The main sources of funding for health services research include several federal agencies such as the Agency for Healthcare Research and Quality (AHRQ)
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From page 31... ...
Quality improvement is now also on the agendas of many medical specialty certifying boards, said David Stevens of the Association of American Medical Colleges. Andrea Kabcenell of the Institute for Healthcare Improvement commented that getting involved in quality improvement needs to be made more democratic and accessible.
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From page 32... ...
Policy levers, such as accreditation or payors providing matching funds for quality improvement research, must be utilized. Quality improvement research can also be leveraged by strategies focused on individual researchers, for example, providing salary support for protected research time or altering tenure and promotion policies to respond to the special barriers of interdisciplinary research.
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From page 33... ...
. These concerns argue, Davidoff said, that it would be best if the health care system itself developed ethical guidelines for quality improvement instead of allowing the task to be subsumed by the administrative structure responsible for clinical research ethics.
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From page 34... ...
By contrast, quality improvement studies are not performed under such tightly controlled conditions. This is by design, Davidoff noted, but it makes it difficult to know if "proven interventions" in quality improvement research are generalizable and actually yield improved outcomes.
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From page 35... ...
The difficulties are augmented when the research is performed in an interdisciplinary setting, Pincus added. BARRIER OF SUSTAINABILITY Scot Webster spoke of the important role that culture change plays in improving quality.
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From page 36... ...
ADVANCING QUALITY IMPROVEMENT RESEARCH advances in quality improvement include accounting for change, managing competing demands, and understanding that change is complex. Purely mechanistic approaches for change in complex systems are often inadequate; instead, more complex, adaptive approaches may be necessary.
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