Quality of care and Implementation
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Quality and safety of care
Different indicators can be used to measure the various aspects of quality of care, e.g. occurrence of complications, mortality or improved functioning due to surgery. Such indicators do not necessarily point into the same direction. Research efforts are focused on improving our ability to measure the concept of quality of care, for instance by combining different outcomes that are available, which may not only give a more comprehensive overview of the quality of care delivered but also enable more reliably distinguishing between healthcare providers in their performance. In addition, new methodologies may detect a worsening performance more quickly so that fewer patients risk being harmed, or enhance hospital feedback by providing direction in what group of patients care can be improved.
…Quality and safety of care
Different indicators can be used to measure the various aspects of quality of care, e.g. occurrence of complications, mortality or improved functioning due to surgery. Such indicators do not necessarily point into the same direction. Research efforts are focused on improving our ability to measure the concept of quality of care, for instance by combining different outcomes that are available, which may not only give a more comprehensive overview of the quality of care delivered but also enable more reliably distinguishing between healthcare providers in their performance. In addition, new methodologies may detect a worsening performance more quickly so that fewer patients risk being harmed, or enhance hospital feedback by providing direction in what group of patients care can be improved.
Interventions to improve the quality of care, often use some form of audit and feedback, where for instance hospitals receive feedback on how they perform compared to other hospitals in key patient outcomes, and this performance is frequently monitored (audited) to detect improvements or deteriorations. However, the effectiveness of this type of interventions varies widely, and we need to increase our understanding how to improve the effectiveness of this and other type of interventions, and in such a way that improvements are sustained.
The IQ Joint study is an example of a project within this theme, that combines developing and testing new methodologies and testing the effectiveness of an intervention in a RCT nested in the Dutch Arthroplasty Registry to improve the quality of orthopaedic care.
Another example is the CORE-MD study, funded by the EU, where we aim to develop a decision framework for regulators on how to assess the performance of medical devices, endpoints included and the methods used to combine outcomes into a single benchmark.
Implementation and de-implementation research
New evidence, evidence based practice guidelines and innovations become available every day, which ideally should be integrated promptly in decision-making processes by doctors and their patients (implementation). Similarly, we may also need to reduce or abandon some practices because these are not useful anymore in all patients (de-implementation). The steps to be taken for implementation and de-implementation are similar, but de-implementation is not necessarily the other side of the same coin given the uncertainty and psychological biases, such as confirmation bias and loss aversion, that play a role in the sustained delivery of low-value care. Research efforts focus on the exploration of the characteristics of innovators versus laggards, to identify barriers and facilitators for implementation and de-implementation, to test the effectiveness and cost of interventions to accelerate implementation or de-implementation of medical practices, and last – but not least- the conceptual differences between implementation and de-implementation. Such knowledge can then be applied to implement interventions faster and more effectively. This research is performed in many clinical areas and closely related to quality improvement research.
…Implementation and de-implementation research
New evidence, evidence based practice guidelines and innovations become available every day, which ideally should be integrated promptly in decision-making processes by doctors and their patients (implementation). Similarly, we may also need to reduce or abandon some practices because these are not useful anymore in all patients (de-implementation). The steps to be taken for implementation and de-implementation are similar, but de-implementation is not necessarily the other side of the same coin given the uncertainty and psychological biases, such as confirmation bias and loss aversion, that play a role in the sustained delivery of low-value care. Research efforts focus on the exploration of the characteristics of innovators versus laggards, to identify barriers and facilitators for implementation and de-implementation, to test the effectiveness and cost of interventions to accelerate implementation or de-implementation of medical practices, and last – but not least- the conceptual differences between implementation and de-implementation. Such knowledge can then be applied to implement interventions faster and more effectively. This research is performed in many clinical areas and closely related to quality improvement research.