I attended a conference on quality and patient safety, and some of the speakers mentioned some interesting resources. I googled them and saved the links here.

Patient Quality Indicators. “The Prevention Quality Indicators (PQIs) are a set of measures that can be used with hospital inpatient discharge data to identify quality of care for “ambulatory care sensitive conditions.” These are conditions for which good outpatient care can potentially prevent the need for hospitalization or for which early intervention can prevent complications or more severe disease.” Available at http://www.qualityindicators.ahrq.gov/modules/pqi_overview.aspx.

Clinical classification software for ICD-9-CM. “The Clinical Classifications Software (CCS) for ICD-9-CM is a diagnosis and procedure categorization scheme that can be employed in many types of projects analyzing data on diagnoses and procedures. CCS is based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), a uniform and standardized coding system. The ICD-9-CM’s multitude of codes – over 14,000 diagnosis codes and 3,900 procedure codes – are collapsed into a smaller number of clinically meaningful categories that are sometimes more useful for presenting descriptive statistics than are individual ICD-9-CM codes.” Available at https://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp.

MedEd Portal. “A peer-reviewed, open-access journal that promotes educational scholarship and dissemination of teaching and assessment resources in the health professions” Available at https://www.mededportal.org/.

Toward stronger evidence on quality improvement. Draft publication guidelines: the beginning of a consensus project. “In contrast with the primary goals of science, which are to discover and disseminate new knowledge, the primary goal of improvement is to change performance. Unfortunately, scholarly accounts of the methods, experiences, and results of most medical quality improvement work are not published, either in print or electronic form. In our view this failure to publish is a serious deficiency: it limits the available evidence on efficacy, prevents critical scrutiny, deprives staff of the opportunity and incentive to clarify thinking, slows dissemination of established improvements, inhibits discovery of innovations, and compromises the ethical obligation to return valuable information to the public.The reasons for this failure are many: competing service responsibilities of and lack of academic rewards for improvement staff; editors’ and peer reviewers’ unfamiliarity with improvement goals and methods; and lack of publication guidelines that are appropriate for rigorous, scholarly improvement work. We propose here a draft set of guidelines designed to help with writing, reviewing, editing, interpreting, and using such reports. We envisage this draft as the starting point for collaborative development of more definitive guidelines. We suggest that medical quality improvement will not reach its full potential unless accurate and transparent reports of improvement work are published frequently and widely.” Available at http://qualitysafety.bmj.com/content/14/5/319.short.

Improving the Quality of Quality Improvement Reporting. Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 Guidelines “SQUIRE provides an explicit framework for those “studying QI” by describing in-depth the improvement interventions, their site-specific contexts, and their results. However, despite endorsement by multiple journals, SQUIRE has not been widely adopted. SQUIRE 2.0, which is the next iteration, has been modified based on significant stakeholder input to simplify and streamline the reporting standards.6 The second version outlines 18 items that should be considered in reporting a QI effort, but allows for flexibility in determining whether each item is necessary or appropriate.” Available at https://jamanetwork.com/journals/jamasurgery/fullarticle/2482672.

“Without data, you’re just another person with an opinion.” W. Edwards Deming. As quoted at https://www.goodreads.com/author/quotes/310261.W_Edwards_Deming.

The first, an editorial on data sharing, warns us against “data parasites.” These are

people who had nothing to do with the design and execution of the study but use another group’s data for their own ends, possibly stealing from the research productivity planned by the data gatherers, or even use the data to try to disprove what the original investigators had posited.

Apparently, in order to avoid being a data parasite, you have to work closely with the original investigators. You can’t work on an “obvious extension” and your work has to acknowledge and offer coauthorship to the group that accumulated the original data.

To that I say, Pshaw! Some research can and should involve close work with the original investigators, but if failure to do so is parasitic, then the whole field of meta-analysis has been condemned.

There’s a quote by Harry Truman that is relevant here.

It is amazing what you can accomplish if you do not care who gets the credit.

If you are afraid to share your data because you are worried about someone else getting credit for your hard work, then I say you should get out of the business of medical research. Sure, you should keep your data private until you’ve written up the bulk of your research. But after that, cast your data upon the waters, and see what happens.

The second, an editorial against the standardization of the delivery of medical care,  claims that lean six sigma experts intent on standardizing every aspect of medical care are lurking outside your office with a stopwatch. They invent a term, medical Taylorism, that is a gross mischaracterization of lean six sigma.

Perhaps some bureaucrats have co-opted the quality improvement movement to squeeze a few dollars of profit at the expense of medical care. But anyone familiar with the movement will recognize lean six sigma as a rebellion against Taylorism. Wikipedia has a nice summary of Taylorism, by the way, in an article on scientific management, if you’re unfamiliar with this term. W. Edwards Deming, a pioneer in quality improvement, was a very harsh critic of Taylorism, and most current proponents of quality improvement would probably concur with his assessment. See this blog post, for example.

It’s important to realize that some aspects of medical care cannot and should not be standardized. But if anything, there is too little standardization, and rates of c-sections, for example, show variations far beyond what can be accounted for by individual patient differences.

Both editorials take points (collaborate when you can, don’t standardize everything) that do have some limited validity and take them to extremes. They set up straw men (data parasites, medical Taylorism)  to convince you to embrace their message to keep these bad things from happening.