Patient safety and quality of care
Information on quality of care is increasingly used for decisions by different stakeholders:
- Patients choose in which hospital they want to be treated
- Insurance companies purchase care
- Providers of care aim to evaluate and improve their care
Different indicators can be used to measure the various aspects of quality of care, e.g. occurrence of complications, mortality or improved functioning due to surgery. Such indicators do not necessarily point into the same direction. Research efforts are focused on improving our ability to measure the concept of quality of care, by combining different outcomes that are available, and evaluate new dimensions that matter to patients (e.g. improved well-being or patient-reported outcome measures, PROMs). Related questions are whether we can reliably distinguish the performance on these indicators between providers, which factors explain differences between providers, and how we can then improve the quality of care within hospitals.
Implementation and de-implementation research
New evidence, evidence based practice guidelines and innovations become available every day, which ideally should be integrated promptly in decision-making processes by doctors and their patients (implementation). Similarly, we may also need to abandon some practices because these are not useful anymore (de-implementation). The steps to be taken for implementation and de-implementation are similar, but de-implementation is not necessarily the other side of the same coin given known psychological biases, such as confirmation bias and loss aversion. Research efforts focus on the exploration of the characteristics of innovators versus laggards, to identify barriers and facilitators for implementation and de-implementation, to test the effectiveness and cost of interventions to accelerate implementation or de-implementation of medical practices, and last – but not least- the differences between implementation and de-implementation. Such knowledge can then be applied to implement interventions faster and more effectively. This research is performed in many clinical areas and closely related to quality improvement research.