'QI' projects may -- or may not -- improve patient safety an...( Mandatory classes that aim to improv...),Health

Mandatory classes that aim to improve the quality of medical care seem to successfully teach doctors new concepts but dont necessarily improve patient outcomes, suggests a thorough review of articles that examine quality improvement (QI) curricula.

Identifying and fixing problems is something that doctors have learned to do when faced with diseases, but those problem-solving skills dont necessarily translate into identifying or fixing health care systems in a hospital even after taking special classes, says Romsai Boonyasai, an internist at The Johns Hopkins Hospital and co-author of the review in the Sept. 5 issue of the Journal of the American Medical Association.

QI programs are designed to teach the basics of spotting and addressing problems inherent in complex medical systems, such as lack of standardized processes to reduce medical errors or inadequate communication among multiple layers of caregivers to patients whose care is complicated and whose hospital stays are compressed.

For example, even though patients may receive correct diagnoses when they visit a hospitals emergency room, a lack of organization in the hospitals medical records department or a dearth of medical supplies due to mishandled orders could affect a patients treatment.

As of 2003, training programs for medical residents are required to include QI curricula for medical schools to maintain accreditation. QI classes are also part of training programs for medical students and continuing education programs for working doctors. However, Boonyasai explains, whether QI classes make a difference in physician knowledge or patient outcomes is unknown.

To evaluate the effectiveness of various QI curricula, Boonyasai and his colleagues systematically searched databases of medical articles for those mentioning QI in health care. They narrowed their focus to 39 articles that described teaching students and clinicians QI methods.

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