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The newspaper of The Johns Hopkins University October 22, 2007 | Vol. 37 No. 8
'QI' Projects May — or May Not — Improve Patient Safety, Outcomes

By Christen Brownlee
Johns Hopkins Medicine

Mandatory classes that aim to improve the quality of medical care seem to successfully teach doctors new concepts but don't necessarily improve patient outcomes, suggests a thorough review of articles that examine quality improvement curricula.

"Identifying and fixing problems is something that doctors have learned to do when faced with diseases, but those problem-solving skills don't necessarily translate into identifying or fixing health care systems in a hospital, even after taking special classes," said Romsai Boonyasai, an internist at The Johns Hopkins Hospital and co-author of the review published in the Sept. 5 issue of the Journal of the American Medical Association.

Quality improvement programs are designed to teach the basics of spotting and addressing problems inherent in complex medical systems, such as lack of standardized processes to reduce medical errors, or inadequate communication among multiple layers of caregivers to patients whose care is complicated and whose hospital stays are compressed.

For example, even though patients may receive correct diagnoses when they visit a hospital's emergency room, a lack of organization in the hospital's medical records department or a dearth of medical supplies due to mishandled orders could affect a patient's treatment.

As of 2003, in order for medical schools to maintain accreditation, training programs for residents are required to include quality improvement curricula. QI classes are also part of training programs for medical students and continuing education programs for working doctors. However, Boonyasai says, whether those classes make a difference in physician knowledge or patient outcomes is unknown.

To evaluate the effectiveness of various curricula, Boonyasai and his colleagues systematically searched databases of medical articles for those mentioning quality improvement in health care. They narrowed their focus to 39 articles that described teaching QI methods to students and clinicians.

When Boonyasai's team evaluated these articles, they found that most suggested an improvement in students' and clinicians' knowledge of QI concepts — noting, for example, how well they scored on QI concept tests. However, those articles that evaluated the effect of these training programs on patient outcomes found a mixed bag, with some showing improvement in patient outcomes after QI and some showing no effect at all.

The good news, the researchers say, is that they found several common characteristics in programs that led to more positive patient outcomes: providing students and clinicians with ongoing access to their own performance, teaching them to address problems with small steps of trial and error, and providing them with active guidance from QI experts throughout the problem-solving process.

Boonyasai notes that the field of QI as it applies to medicine is still in an early state. Yet, he adds, identifying those characteristics that improve patient outcomes can help medical training programs identify more effective QI curricula.

The authors of the JAMA article are members of the Quality Improvement Curriculum Committee appointed by the Society of General Internal Medicine, which provided financial support for this study. Other financial support was provided by the National Heart, Lung and Blood Institute; National Research Service Award–Health Resources and Services Administration; and Osler Center for Clinical Excellence at Johns Hopkins University.


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