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August 2017

Assumptions of Quality Medicine: The Role of Uncertainty

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
JAMA Otolaryngol Head Neck Surg. 2017;143(8):753-754. doi:10.1001/jamaoto.2017.0257

Despite great advances in quality improvement in health care over the past few decades, the health care delivery system is still under increasing pressure to achieve safe, effective, patient-centered, timely, efficient, and equitable care to all patients.1 Perfection in this realm is a laudable goal, but efforts to achieve these 6 principles have focused mainly on health care policies that use rewards and penalties (pay-for-performance) to incentivize physicians and other health care providers to design their care in line with these principles. However, economic incentive policies often make significant assumptions about the behavior of the subjects they seek to influence, and those assumptions may not be correct.2 Uncertainty in health care decision making is underemphasized in health care policy, and neglecting that uncertainty weakens our initiatives to improve care.