New concepts and approaches in health care quality improvement

Efforts to improve the quality of medical care in the United States will require a major transformation in the way health care is organized, financed, and delivered. The October issue of Medical Care is a special issue focusing on the critically important topic of quality improvement in health care. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

A consistent focus on quality improvement is essential to address the profound challenges facing the U.S. health care system. The seven papers presented in the special issue of Medical Care highlight innovative new concepts and approaches in health care quality improvement.

Health Care Quality Improvement—Transforming the US Health Care System

The papers in the special issue reflect the knowledge and experience of respected leaders in the field. Presentations include new initiatives already being implemented, emerging concepts in health care quality improvement, and recommendations for future research. Topics (and lead authors) include:

•Factors that advance and hinder progress in transforming the delivery of cancer care. Efforts to improve cancer care—such as changes in the information market, organizational accountability, and consumer empowerment—may have important lessons for the larger health care system. (David A. Haggstrom, M.D., M.A.S., Rodebush VA Medical Center, Indianapolis)
•The role of health information technology as a central part of quality improvement efforts within the Veterans Health Administration. The use of "telehealth" technologies may help patients with chronic health problems be more successful in managing their own care at home. (Neale R. Chumbler, Ph.D., Roudebush VA Medical Center)
•New research into the science of quality improvement implementation. Evidence-based approaches to implementation science will be essential to overcoming barriers to putting effective programs into practice. (Jeffrey A. Alexander, Ph.D., University of Michigan School of Public Health)
•A 15-year developmental research program to transform primary medical care. The researchers believe a "complexity science" approach provides the most promising way to develop strategies that will be truly effective in changing health care practice. (Benjamin F. Crabtree, Ph.D., Robert Wood Johnson Medical School, Somerset, N.J.)
•Lessons learned in the development of a Clinical Practice Model framework for transforming medical practice at the point of care. Rather than a "quick fix" mindset, the authors emphasize the need for a Professional Practice Framework to achieve greater clinical integration and sustainable transformation. (Bonnie Wesorick, R.N., M.S.N., Clinical Practice Model Resource Center, Grand Rapids, Mich.)
•A new model of organizational change, viewing the organization more as an ongoing "conversation" among everybody involved, rather than a "machine" that needs to be fixed. A concept of "emerging design"—allowing for curiosity, flexibility, and experimentation—may be more effective in achieving lasting change. (Anthony L. Suchman, M.D., of University of Rochester School of Medicine and Dentistry)
•A research agenda for advancing health care transformation, from organization and financing to delivery of care. The recommendations were developed for the 10th Biennial Regenstrief Institute Conference—a health system research conference for health services and social sciences researchers from a variety of disciplines. (Mindy Flanagan, Ph.D., Indiana University).