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Editor's Correspondence
November 24, 2003

Quality Improvement Projects: Inaction Presents the Greatest Risk

Arch Intern Med. 2003;163(21):2648-2649. doi:10.1001/archinte.163.21.2648

Quality improvement (QI) projects have 2 fundamental aims: (1) to eliminate unnecessary and undesirable variation in medical service delivery and (2) to increase the adherence of medical practice to widely accepted standards of care. Quality improvement projects are generally undertaken with the guidance of a study group composed of representatives from stakeholders involved in the process and are based on major consensus guidelines. True QI projects target processes of cares and not outcomes, although processes of care strongly linked with favorable outcomes are preferred. A process of care can be defined as a medical decision or a clinical intervention that is performed for a patient or group of patients in the course of managing or preventing a disease. This decision or intervention is usually made at the site of care. Thus, decreasing length of stay, which was one of the examples by Lo and Groman,1 alters an outcome, not a process of care, and should not be considered a QI project. On the other hand, increasing the use of β-blockers in the post–acute myocardial infarction patient, which has been strongly linked with decreased mortality, is an example of an excellent QI project. Quality improvement projects do not attempt to test new or novel drugs or devices. They do not aim to save money for patients, hospitals, or anyone else. It may sometimes be true, however, that by improving a process of care, a by-product of the QI project may be a cost savings or a shorter length of stay.

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