Research and Quality Assurance
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Slide 1 :
Research and Quality Assurance Not the same thing! James L. Vacek, MD
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Research and Quality Assurance (QA) May use the same tools (a database and data collectors) But differ in most other key areas The type of data collected The goals of the endeavor The analysis of the data The duration of study
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Definitions research n. Scholarly or scientific investigation or inquiry. Close, careful study. v. To study (something) thoroughly so as to present in a detailed, accurate manner American Heritage Dictionary 2000 QA A planned and systematic pattern of all actionsnecessary to provide adequate confidence that the product optimally fulfils customers' expectations, i.e. that it is problem-free and well able to perform the task it was designed for. DieNet On-line Dictionary 2003
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Quality Assurance – Goals Study patient care parameters Assess effects of treatment, success rates, duration of hospital stay, complications, appropriate use of resources Provide comparative data to other institutions or national registries Generally a “single look” during hospital stay Ultimately, improve direct patient care
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QA Goals The data may be used by the institution to improve care or promote services Comparative data may be used by insurers or other agents to direct support Public dissemination on web sites to impact provider choice
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With QA, patient care is improved by identifying strengths and problems in the system, and using this data to assure that quality services are provided which meet or exceed “standard of care.”
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QA studies health care provider performance and provides a “report card” to study, compare, and hopefully improve outcomes“outcomes” in this context relate to direct, immediately measurable events such as life/death, procedural success, duration of hospital stay, and costs
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QA Usually a limited data set Study parameters are well defined and unlikely to change during the course of an analysis Usually not used to study a scientific hypothesis or be “hypothesis-generating” Short term analysis of immediate outcomes Subjective data (patient satisfaction surveys) are valid and important Statistical analysis derived from business models
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Research Goals -1 Collect a large, prospectively defined data set, but acknowledge that ongoing refinement will occur Longitudinal data collection is mandatory Hypotheses are studied and new hypotheses generated By nature objective Statistical analysis derived from hard science models
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Research Goals - 2 Data used for presentation and publication in national forums Increasingly part of public domain in lay media Establishes an institution as “advanced, cutting edge, academic, elite, desirable” Necessary at present to certify training programs
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Research Goals - 3 Attracts premier physicians, scientists and support staff Grant support – may be substantial but requires mature program Attracts industry attention for provision of new technology, techniques, and treatments. Financial support likely and partnerships feasible
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Research impacts patient care in less immediately tangible, but critical long-term areasThe state of medical knowledge is advanced, the framework to improve patient care is developed
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Research integrates the personnel, equipment and data to “grow” medical knowledge and improve patient care, allowing for advances in disease prevention, recognition and treatmentThis is not the methodology of QA, which provides a scorecard of performance
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Research Data Collection Must include all hospital, office, and procedural outcomes, not just a limited number of events A large set of multiple data points must be collected with a “repeated-look” database structure to allow detailed analysis over time.
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Research Outcomes In research, “outcomes” describe a myriad of short and long term patient responses to treatment as well baseline differences in demographics and characteristics that may impact future results. It includes everything that QA may study, as well as many other parameters that may not show changes for months to years.
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Research demands that periodic updates of the dataset are performed – usually via telephone, office, or mailed surveys on an annual basis
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The data collected for research can be linked to: QA initiatives National registries Office and hospital electronic medical record systems
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Due to the limited nature of QA datasets, useful medical research cannot usually be done from a QA data repositoryMuch of the robustness of the data available in hospital and office EMRs is lost when translated into QA datasets
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Research and QA are both vitally important, but they are not the same thingQA data collection cannot substitute for a research database
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More Definitions Research n 1: systematic investigation to establish facts 2: a search for knowledge; [syn: inquiry, enquiry] v 1: inquire into [syn: search, explore] 2: attempt to find out in a systematically and scientific manner Websters Dictionary 1996 Quality Assurance n: a program for the systematic monitoring and evaluation of the various aspects of a project, service, or facility to ensure that standards of quality are being met Merriam-Websters Medical Dictionary 2002
Slide 21 :
Summary The basic tools which are used for research and QA may be similar, but their implementation, output, and goals are very different
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Thank You!James L. Vacek, MD
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