Author Affiliations: American Board of Internal Medicine, Philadelphia, Pennsylvania.
Significant quality-of-care gaps are well documented in the United States.1,2
These reports have focused mostly on underuse of performance measures of important processes of care, and some outcomes of care.1
Others have argued that the cause of underuse of these evidence-based processes of care is usually not deficient physician knowledge about whether to perform the examination or order the test, but rather poorly designed, dysfunctional microsystems of care unable to deliver effective, efficient, and reliable care.3,4
Holmboe ES, Lipner R, Greiner A. Assessing Quality of Care: Knowledge Matters. JAMA. 2008;299(3):338–340. doi:10.1001/jama.299.3.338
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