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  1. Toward QI² : Quality Improvement of Quality Improvement Through Randomized Controlled Trials.

    Article - En anglais


    Many health care organizations-including most managed care organizations (MCOs) - measure the success of quality improvement (QI) interventions using the before-after comparison.

    Howewer, before-after comparisons may lead to false conclusions about the efficacy of a QI intervention, reflecting measurement bias, confounding due to extraneous variables, regression toward the mean, and secular trends.

    Performing a randomized controlled trial (RCT) of a QI intervention may result in net cost savings to the organization, as demonstrated in an example of a QI intervention to increase the use of inhaled steroids by persons with moderate to servere asthma.


    Decision analysis and probability theory were applied to calculate the expected financial impact of three approaches to the design and evaluation of QI interventions.

    One approach (the « interveneall » strategy) involved the standard before-after measurement.

    The other two approaches involved RCTs of slightly different configurations, one in which the majority receives the intervention and the other in which only a minority receives the intervention.


    The expected net costs to the health care organization of each of the three QI intervention and evaluation strategies were estimated, assuming that the intervention increase inhaled steroid use.

    The optimal strategy varied, depending on the predicted effectiveness of the intervention. (...)

    Mots-clés Pascal : Essai clinique, Chimiothérapie, Traitement, Soin, Amélioration, Processus, Méthodologie, Stratégie, Asthme, Maladie, Analyse coût efficacité, Sciences économiques, Efficacité, Evaluation, Appareil respiratoire pathologie, Qualité, Bronchopneumopathie obstructive

    Mots-clés Pascal anglais : Clinical trial, Chemotherapy, Treatment, Care, Improvement, Process, Methodology, Strategy, Asthma, Disease, Cost efficiency analysis, Economics, Efficiency, Evaluation, Respiratory disease, Quality, Obstructive pulmonary disease

    Logo du centre Notice produite par :
    Observatoire Régional de la Santé Auvergne-Rhône-Alpes

    Code Inist : 002B30A11. Création : 31/05/1999.