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Quality Health Care FREE

Linda A. Headrick, MD; Duncan Neuhauser, PhD
JAMA. 1995;273(21):1718-1720. doi:10.1001/jama.1995.03520450088046
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Health professionals are reporting progress in the application of improvement principles and methods to clinical care. One year ago we wrote, "Continuous improvement is a reality in clinical medicine.... Examples of improvement in direct patient care finally have emerged in the literature."1 The pace is increasing. A recent MEDLINE search of the entries "total quality management" combined with "clinical" from 1985 to 1994 revealed 125 English-language citations, with 91 written from 1991 through 1994. A similar search of the entries "continuous quality improvement" combined with "clinical" uncovered 82 articles, all but 15 published after 1991.

The most successful efforts combine professional knowledge (such as pathogenesis and therapeutics) with "knowledge for improvement," as described by Batalden and Nolan2 and elaborated on by Batalden and Stoltz.3 Knowledge for improvement incorporates an understanding of systems, statistical variation, the psychology of work and change, and the scientific method. We will focus

REFERENCES

Headrick LA, Neuhauser D.  Quality health care. JAMA . 1993;;271:1711-1712.
Batalden PB, Nolan TW.  Knowledge for the leadership of continual improvement in healthcare.  In: Taylor RJ, ed. Manual of Health Service Management . Gaithersburg, Md: Aspen Publishers; 1993;.
Batalden PB, Stoltz PK.  A framework for the continual improvement of health care: building and applying professional and improvement knowledge to test changes in daily work. Jt Comm J Qual Improv . 1993;;19:424-452.
McGarvey RN, Harper JJ.  Pneumonia mortality reduction and quality improvement in a community hospital. Qual Rev Bull . 1993;;19:124-130.
Deming WE. The New Economics . Cambridge, Mass: Massachusetts Institute of Technology, Center for Advanced Engineering Study; 1993;.
Turley K, Tyndall M, Roger C, et al.  Critical pathway methodology: effectiveness in congenital heart surgery. Ann Thorac Surg . 1994;;58:57-65.
Parenti CM, Lederle FA, Impola CL, Peterson LR.  Reduction of unnecessary intravenous catheter use: internal medicine house staff participate in a successful quality improvement project. Arch Intern Med . 1994;;154:1829-1832.
Young MJ, Ward R, McCarthy B.  Continuously improving primary care. Jt Comm J Qual Improv . 1994;;20:120-126.
Weingarten SR, Riedinger MS, Conner L, et al.  Practice guidelines and reminders to reduce duration of hospital stay for patients with chest pain: an interventional trial. Ann Intern Med . 1994;;120:257-263.
Bluth EI, Havrilla M, Blakeman C.  Quality improvement techniques: value to improve the timeliness of preoperative chest radiographic reports. AJR Am J Roentgenol . 1993;;160:995-998.
Laffel G, ed. Quality Management in Health Care . Gaithersburg, Md: Aspen Publishers;1992;.
Berwick DB, ed. Eye on Improvement . Boston, Mass: Institute for Healthcare Improvement; 1994;.
Editorial Advisory Board.  Quality improvement in health care: the year behind, the year ahead. Jt Comm J Qual Improv . 1995;;21:5-16.
 Capitation could make hospitals responsible for health quality of entire communities. Qual Improv Total Qual Manage . 1994;;6:77-81.

Figures

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Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

Headrick LA, Neuhauser D.  Quality health care. JAMA . 1993;;271:1711-1712.
Batalden PB, Nolan TW.  Knowledge for the leadership of continual improvement in healthcare.  In: Taylor RJ, ed. Manual of Health Service Management . Gaithersburg, Md: Aspen Publishers; 1993;.
Batalden PB, Stoltz PK.  A framework for the continual improvement of health care: building and applying professional and improvement knowledge to test changes in daily work. Jt Comm J Qual Improv . 1993;;19:424-452.
McGarvey RN, Harper JJ.  Pneumonia mortality reduction and quality improvement in a community hospital. Qual Rev Bull . 1993;;19:124-130.
Deming WE. The New Economics . Cambridge, Mass: Massachusetts Institute of Technology, Center for Advanced Engineering Study; 1993;.
Turley K, Tyndall M, Roger C, et al.  Critical pathway methodology: effectiveness in congenital heart surgery. Ann Thorac Surg . 1994;;58:57-65.
Parenti CM, Lederle FA, Impola CL, Peterson LR.  Reduction of unnecessary intravenous catheter use: internal medicine house staff participate in a successful quality improvement project. Arch Intern Med . 1994;;154:1829-1832.
Young MJ, Ward R, McCarthy B.  Continuously improving primary care. Jt Comm J Qual Improv . 1994;;20:120-126.
Weingarten SR, Riedinger MS, Conner L, et al.  Practice guidelines and reminders to reduce duration of hospital stay for patients with chest pain: an interventional trial. Ann Intern Med . 1994;;120:257-263.
Bluth EI, Havrilla M, Blakeman C.  Quality improvement techniques: value to improve the timeliness of preoperative chest radiographic reports. AJR Am J Roentgenol . 1993;;160:995-998.
Laffel G, ed. Quality Management in Health Care . Gaithersburg, Md: Aspen Publishers;1992;.
Berwick DB, ed. Eye on Improvement . Boston, Mass: Institute for Healthcare Improvement; 1994;.
Editorial Advisory Board.  Quality improvement in health care: the year behind, the year ahead. Jt Comm J Qual Improv . 1995;;21:5-16.
 Capitation could make hospitals responsible for health quality of entire communities. Qual Improv Total Qual Manage . 1994;;6:77-81.
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To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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