Naomi S Bardach1, Michael D Cabana. 1. Department of Pediatrics, University of California, San Francisco (UCSF), San Francisco, California, USA.
Abstract
PURPOSE OF REVIEW: The focus on quality improvement has led to several types of initiatives in pediatric care; however, these programs may lead to potential unintended consequences. RECENT FINDINGS: Unintended consequences of quality improvement programs that have been described are reviewed. Unintended effects on resource utilization include effects on costs, as well as the inability to apply programs across different populations and affect disparities in care. Unintended effects on provider behavior include measurement fixation behavior, as well as 'crowding out' behavior, in which gains in quality in one area may simply occur at the expense of quality of care in another. Patient preferences may not always match specific quality improvement measures. Unintended effects for patients may include decreased patient satisfaction, trust, or confidence in their provider. SUMMARY: Recognition and anticipation of the possible unintended consequences of guideline implementation is a critical step to harnessing all the benefits of quality improvement in practice.
PURPOSE OF REVIEW: The focus on quality improvement has led to several types of initiatives in pediatric care; however, these programs may lead to potential unintended consequences. RECENT FINDINGS: Unintended consequences of quality improvement programs that have been described are reviewed. Unintended effects on resource utilization include effects on costs, as well as the inability to apply programs across different populations and affect disparities in care. Unintended effects on provider behavior include measurement fixation behavior, as well as 'crowding out' behavior, in which gains in quality in one area may simply occur at the expense of quality of care in another. Patient preferences may not always match specific quality improvement measures. Unintended effects for patients may include decreased patient satisfaction, trust, or confidence in their provider. SUMMARY: Recognition and anticipation of the possible unintended consequences of guideline implementation is a critical step to harnessing all the benefits of quality improvement in practice.
Authors: N A Omoigui; D P Miller; K J Brown; K Annan; D Cosgrove; B Lytle; F Loop; E J Topol Journal: Circulation Date: 1996-01-01 Impact factor: 29.690
Authors: Nicole A B M Ketelaar; Marjan J Faber; Signe Flottorp; Liv Helen Rygh; Katherine H O Deane; Martin P Eccles Journal: Cochrane Database Syst Rev Date: 2011-11-09
Authors: Naomi S Bardach; Audrey Lyndon; Renée Asteria-Peñaloza; L Elizabeth Goldman; Grace A Lin; R Adams Dudley Journal: BMJ Qual Saf Date: 2015-12-15 Impact factor: 7.035
Authors: Enihomo M Obadan-Udoh; Jean M Calvo; Sapna Panwar; Kristen Simmons; Joel M White; Muhammad F Walji; Elsbeth Kalenderian Journal: BMC Oral Health Date: 2019-03-01 Impact factor: 2.757
Authors: Anna Sarkadi; Anton Dahlberg; Kajsa Leander; Moa Johansson; Johanna Zahlander; Anna Fäldt; Robert S Kristiansson; Kine Johansen Journal: Int J Integr Care Date: 2021-04-15 Impact factor: 5.120
Authors: Mitchell Goldstein; Leonard R Krilov; Jaime Fergie; Lance Brannman; Sally W Wade; Amanda M Kong; Christopher S Ambrose Journal: Am J Perinatol Date: 2020-04-16 Impact factor: 1.862