After a long absence from my active involvement on the list, I hope you
will not mind if I summarize the responses I received in December
regarding the above question:
1. Can CQI methods (Continuous Quality Improvement) be used to
effectively change prescribing practices?
******Of the few responses I received, it appears that there exists no
systematic review of the literature on this subject. Dr. Greenlagh
attempted to look at this recently, and found very little published
evidence. But, there may be some coming down the pipeline.
Can the pragmatic PDSA quick-cycle testing (i.e. Plan the change; Do the
change, Study the results, Act on the results, & reiterate) be safely
used to reduce costs while improving outcomes, even though it is less
methodologically sound than typical RCTs, etc.
*********As some respondents pointed out, this is similar to the "clinical
Audit" in the UK when the audit is performed for the purpose of defining
gaps in practice (i.e. inconguencies with the best evidence) and
identifying + implementing strategies to close those gaps and evaluate
the effectiveness of the change. The principle of CQI is 'sound', but
evidence to prove it works is lacking (not yet been studied)
The PDSA approach has some inherent strengths, particularly when it
actively involves clinicians and key 'stakeholders' in evaluating their
current practice and making recommendations for change (and
evaluation of that change) based on the best available evidence.
Perhaps the greatest strength of PDSA is that it requires pragmatic
study, and overcomes some of the stalling effects and extreme resource
consumption required by methodologicallly rigorous studies. Hence,
PDSA is probably useful for finding quick answers when there is no
option to wait for more valid studies, and may be better than doing
nothing at all!
*******Any other comments regarding CQI, PDSA, and pragmatic study
are quite welcome!
Thanks again,
Janet E. Martin, PharmD
Evidence-Based Prescribing Guidelines Pharmacist
Project Manager, Evidence-Based Prescribing Initiative
London Health Sciences Centre
London, Ontario, Canada
N6A 4G5
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