The Effect of a Quality Improvement Initiative on the Quality of Other Aspects of Health Care
The Law of Unintended Consequences
Bibliographic Data
| ID | 9101975 |
|---|---|
| Authors | David A Ganz (0009-0004-8512-1641, UCLA Health, corresponding author), Neil Wenger (0000-0002-9884-3967, University of California, Los Angeles), Neil S Wenger, Carol P Roth (RAND Corporation), CAREN J KAMBERG, Caren Kamberg (RAND Corporation), John T Chang (0009-0003-5419-0225, University of California, Los Angeles), Catherine H MacLean (0000-0003-2581-189X, RAND Corporation, corresponding author), Roy T Young (University of California, Los Angeles), David H Solomon (0000-0001-8765-7045, University of California, Los Angeles), Takahiro Higashi (0000-0002-9933-2106, Kyoto University), Lillian Min (0000-0002-4149-5092), David B Reuben (0000-0002-1363-4745, University of California, Los Angeles), Paul G Shekelle (RAND Corporation, corresponding author) |
| Year | 2007 |
| Volume | 45 |
| Issue | 1 |
| Pages | 8-18 |
| Publication date | 2007-01-01 |
| Peer Reviewed | Yes |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/01.mlr.0000241115.31531.15 |
| PMID | 17279017 |
| OpenAlex | W2093572738 |
| Language | EN |
| Citations received | 4 |
| References cited | 20 |
PROBLEM: Policymakers and clinicians are concerned that initiatives to improve the quality of care for some conditions may have unintended negative consequences for quality in other conditions. OBJECTIVE: We sought to determine whether a practice redesign intervention that improved care for falls, incontinence, and cognitive impairment by an absolute 15% change also affected quality of care for masked conditions (conditions not targeted by the intervention). DESIGN, SETTING, AND PARTICIPANTS: Controlled trial in 2 community medical groups, with 357 intervention and 287 control patients age 75 years or older who had difficulty with falls, incontinence, or cognitive impairment. INTERVENTION: Both intervention and control practices implemented case-finding for target conditions, but only intervention practices received a multicomponent practice-change intervention. Quality of care in the intervention practices improved for 2 of the target conditions (falls and incontinence). MAIN OUTCOME MEASURES: Percent of quality indicators satisfied for a set of 9 masked conditions measured by abstraction of medical records. RESULTS: Before the intervention, the overall percent of masked indicators satisfied was 69% in the intervention group and 67% in the control group. During the intervention period, these percentages did not change, and there was no difference between intervention and control groups for the change in quality between the 2 periods (P=0.86). The intervention minus control difference-in-change for the percent of masked indicators satisfied was 0.2% (bootstrapped 95% confidence interval, -2.7% to 2.9%). Subgroup analyses by clinical condition and by type of care process performed by the clinician did not show consistent results favoring either the intervention or the control group. CONCLUSION: A practice-based intervention that improved quality of care for targeted conditions by an absolute 15% change did not affect measurable aspects of care on a broad set of masked quality measures encompassing 9 other conditions
Business · Health care · Health care quality · MEDLINE · Political science · Quality (philosophy) · Quality management · Frailty in Older Adults · Geriatric Care and Nursing Homes · Health Policy Implementation Science · Marketing · Medicine · Nursing
| Unique citing works | 4 |
|---|---|
| Citations per year | 0,21 |
| Citation span | 2007 - 2012 (6) |
| Citation velocity | historical |
| Highly cited | No |
| Citation types | Neutral: 3 |