Opinion

Quality care results from comparing, analyzing data

A message to all physicians from Edward L. Langston, MD, chair of the AMA Board of Trustees.

By Edward L. Langston, MDis a family physician in private practice in Lafayette, Ind. He served as chair of the AMA Board of Trustees during 2007-08. Posted Aug. 6, 2007.

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Elizabeth Bradley, PhD, director of the Health Management program at Yale University School of Public Health, wrote, "Physicians, in particular, like data, and if one can assure them the data are valid, they will respond"

It seems to me that, from the earliest training through continuing patient care experiences in their practices, physicians have assumed they were always providing quality health care services. As residents, it was assumed and reinforced on a daily basis that the techniques and depth of care, rendered as taught by the teaching faculty, were consistent with the then- current highest quality care accepted by the specialty in which they were being trained.

And why not? In an accredited residency program, one could reasonably assume the training met the highest standards of quality care. We accepted and understood that, within those standards of high quality care, alternative techniques, therapeutics and methodology that also met the highest standard of quality health care were permitted and encouraged.

As physicians matured in their practices and medical science pursued newer and better treatment techniques and treatment modalities, newer data would suggest improved modes of therapy that needed to be learned and adopted. Those very same data would often dispel old science and long-held beliefs; previously learned therapies or modalities of treatment needed to be challenged and changed to address a newer and clearer understanding of the science of human physiology, disease process and human pharmacology.

Scientific discovery continues to uncover and expand into areas of unknown or little-known mechanisms of actions, new pathways of interaction, new intermediaries, new surgical techniques and technology, more defined and precise diagnostic techniques and technology and little-understood pharmacokinetics that change therapy from the old to the new, propelling the profession to a higher quality of patient care.

This happens through constantly challenging previously accepted theories and beliefs, by trying new techniques, and by pursing new technology in ways not previously thought of or explored.

That is how we gain new understanding: by constantly measuring, comparing and analyzing data. And these new understandings, in turn, lead our profession to more precise and higher levels of quality care. Given valid data, physicians will and do adopt new treatment modalities and techniques. Not because of novelty for the sake of novelty, or change for the sake of change, but because better care of our patients is the bottom line that drives excellence.

I would argue that "high quality care" should be challenged continuously to ascertain whether current standards and criteria are really the best and most appropriate care available. Physicians are charged with managing that health care to achieve "high quality care." To that end there is a principle in managing care within a practice or system of patient care that states, "You can't mange what you can't measure."

It is difficult for a physician to know what "high quality care" is unless it can be measured and evaluated against currently accepted standards or criteria, based on valid data, and accepted by the profession as valid and evidenced-based. Physicians constantly change therapy based upon such data.

For instance, Circulation recently published new data on drug-eluting stents and non-drug-eluting stents that will change how antithrombolytic therapy will be managed for patients who are recipients of these stents. What do we have? New data, new recommended changes in management of care and a new definition of quality of care for such stents, all based on measurement, collection and analysis of data. This process facilitates changes in what is considered excellence in patient care.

Therefore, as Dr. Bradley so powerfully stated, physicians will and do respond to new, valid data in the constant search for high quality care.

It requires a discerning attitude, a respect for gathering new data and information, measurement of patient outcomes, and comparison with physician-supported standards and criteria for excellence.

That attitude is a mark of a caring, respectful and motivated profession. Physicians have that attitude, and consequently it drives us as physicians to achieving high quality care for our patients that is consistent, for instance, with the Agency for Healthcare Research and Quality definition of "high quality care," by "doing the right thing, at the right time, in the right way for the right patient."

Edward L. Langston, MD is a family physician in private practice in Lafayette, Ind. He served as chair of the AMA Board of Trustees during 2007-08.

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