Effective Clinical Practice
LETTER TO THE EDITOR
Effective Clinical Practice, September/October 2000.
I read "Failure of a Continuous Quality Improvement Intervention to Increase the Delivery of Preventive Services" (1) with concern. The authors of the study and accompanying editorial profess not to know why CQI fails. During the past several years, economic forces driven by managed care have shortened patient visits, increased patient load, decreased physician incomes, and no doubt caused the "turmoil" in the clinics described in the article. At the same time, HMOs have mandated attention to dozens of primary care variables, to be addressed during these short visits, under the guise of "quality of care." Quality of care, by necessity, has come to mean that which can be measured. Tetanus shots and checklists are easy to quantify. Discussions with patients are not. Nor are prospective studies of the value of most of these variables available.
An expensive randomized, controlled trial is not necessary to elucidate why CQI fails. The beleaguered "primary care physician" is already struggling to diagnose and treat without compromising the doctor-patient relationship. That is the "burning platform." (2) If managed care companies truly feel that these measures are important, they should be emphasized with community outreach programs, delegation to ancillary personnel, or appropriate compensation.
Sheila Feit, MD
The authors chose not to respond.