The unintended consequences of quality improvement

Naomi S. Bardach, Michael D. Cabana

Research output: Contribution to journalReview article

23 Scopus citations

Abstract

Purpose of review: The focus on quality improvement has led to several types of initiatives in pediatric care; however, these programs may lead to potential unintended consequences. Recent findings: Unintended consequences of quality improvement programs that have been described are reviewed. Unintended effects on resource utilization include effects on costs, as well as the inability to apply programs across different populations and affect disparities in care. Unintended effects on provider behavior include measurement fixation behavior, as well as 'crowding out' behavior, in which gains in quality in one area may simply occur at the expense of quality of care in another. Patient preferences may not always match specific quality improvement measures. Unintended effects for patients may include decreased patient satisfaction, trust, or confidence in their provider. Summary: Recognition and anticipation of the possible unintended consequences of guideline implementation is a critical step to harnessing all the benefits of quality improvement in practice.

Original languageEnglish (US)
Pages (from-to)777-782
Number of pages6
JournalCurrent Opinion in Pediatrics
Volume21
Issue number6
DOIs
Publication statusPublished - Dec 1 2009
Externally publishedYes

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Keywords

  • Asthma
  • Clinical practice guidelines
  • Pay for performance
  • Quality improvement
  • Unintended consequences

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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