Knowledge and Evaluation Research Unit - Victor M. Montori

KER - Quality of Care Research

Our objectives are to "harmonize" and "accelerate" quality of care research which follows a series of activities from:

1. Science (Evidence-based medicine)
2. Action (Quality improvement projects)
3. Measures (Differentiating performance)
4. Payment (Aligning reimbursement with best performance)

These 4 essential activities are analogous to the "Plan-Do-Check-Act" cycle for performance improvement in other business or engineering models. Unfortunately, this cycle for improvement in healthcare has historically required up to 25 years. Our aims are to develop innovative methods for quality of care research that overcome traditional barriers, emphasize collaboration, and deliver the most effective and efficient care to our customers.

The central challenge in quality

There are several key factors and design attributes to consider for "what" and "how" to improve quality of care.

1. We must be able to measure, do risk adjustment, and classify differential levels of outcomes and quality of care. In addition, coordination of these measures across payers and finding a proper balance between measure validity and the cost of data collection are important.
2. We must be able to attribute patient-specific outcomes and quality of care to individual physicians or organizations. Care is currently dispersed across multiple physicians and/or organizations and represents a major challenge for how quality of care is attributed at the provider or organization level.
3. We must decide what level of performance to reward such as rewarding for relative improvement from baseline performance or rewarding for achievement of an absolute threshold performance.
4. We must consider that the amount of the economic incentive must be large enough to have the intended effect, but also be aware that there is no incremental money to spend for the system as a whole.
5. We must study and be vigilant not to worsen current inequities and disparities in healthcare access and services.