Quality and Data Base Management

¶ … healthcare organizations fail to implement sound quality improvement initiatives? Identify barriers and constraints to QI (quality improvement)

Improving the overall quality of any organization is a challenge -- yet the challenge often seems much greater, given the institutional barriers and constraints faced by the health care industry. First of all, there is the difficulty of measuring quality of care given the financial constraints imposed by insurance. The Institute for Health Care Improvement has suggested health care organizations be publicly profiled and assigned to varying rated tiers on the basis of their performance on quality. But currently, physicians and hospitals are often compensated solely based on the sheer dollar amount of care they provide, which is usually greater depending on the patient's length of stay. This discourages the use of new treatments and therapies that may send patients home sooner. Even serious medical errors may be financially rewarded if they justify additional charges. (NCQA, 2003)

Thus one constraint is the insurance compensation structure in the industry. But another formidable barrier is also patient complacence, even when patients are compensated. With many ailments like heart disease or diabetes practitioners know how to treat it but the personal practice of medicine needs to catch up with institutional medical knowledge. "More than 57,000 people will die this year because there is a huge gap between what we know and what we do." For example, "only about 40% of the 31 million Americans with diagnosed high blood pressure have their blood pressure adequately controlled. An increase to 68% (the level already achieved by the nation's top health plans) would save an estimated 28,000 lives next year."(NCQA, 2003) But even in this area, some blame must be placed on the barriers of the industry, for the lack of a systematized sharing of patient records means that when a patient changes insurance plans, changes doctors, and changes locations of care, his or her previous record and family history might not be accessible to the attending physician. This can result in some instances that the attending practitioner is lacking treatment or case history information regarding a patient's past obesity, smoking history, a pattern of past blood sugar instability, a history of hypertension in the family, or other potentially vital or useful data.