Quality Assurance/Quality Improvement “QA/QI” projects & the ICTS JIT Program
JIT-specific: Did you know that the ICTS Just-In-Time (JIT) Core Usage Funding Program can be used to obtain data that will lead to a concrete improvement in patient care (Quality Assurance/Quality Improvement “QA/QI” projects) at Barnes-Jewish Hospital or St. Louis Children’s Hospital? Within your project application, you will need to identify the potentially improved tools/processes in order for your proposal to be eligible. We encourage applicants seeking quick access to funding for advancing medical knowledge to improve human health to review our program website for more information.
WashU Definition of QA/QI
- Quality Assurance is defined as a program for the systematic monitoring and evaluation of the various aspects of a project, service, or facility to ensure that standards of quality are being met.
- Quality Improvement is a formal approach to the analysis of performance and systematic efforts to improve it.
Differences between QA/QI and Research 3
| Points to consider | Research | QA/QI |
|---|---|---|
| Purpose | To test a hypothesis OR establish clinical practice standards where none are accepted | To continuously assess or promptly improve a process, program, or system; OR improve performance as judged by accepted/established standards |
| Starting Point | To answer a new question or test a hypothesis | To improve performance or patient care |
| Benefits | Designed to contribute to generalizable knowledge and may or may not benefit subjects | Designed to promptly benefit a process, program, or system and may or may not benefit patients |
| Risks/Burdens | May place subjects at risk and stated as such | By design, does not increase patient’s risk, with exception of possible privacy/confidentiality concerns |
| Data Collection | Systematic data collection | Systematic data collection |
| End Point | Answer a research question | Promptly improve a program/process/system |
| Testing/Analysis | Statistically prove or disprove a hypothesis | Compare a program/process/system to an established set of standards |
| Participant Obligation | No obligation of individuals to participate | Responsibility to participate as component of care |
| Effect on program or practice | Findings are generally not expected to immediately affect or change practice | Findings are expected to directly and immediately affect institutional practice |
Quality Assurance and Quality Improvement (QA/QI) FAQs
Quality Assurance (QA) and Quality Improvement (QI) are complementary endeavors for attaining continual improvement in health care quality. QA/QI generally refers to a range of activities conducted to assess, analyze, critique, and improve current processes of health care delivery in the local institutional setting. QA/QI activities are typically observational and unobtrusive and can involve the collection and analysis of data to which investigators have legitimate access through their institutional roles. These activities do not prevent or hinder the delivery of clinically indicated care to patients, nor do they impose more than minimal additional risks or burdens on patients.1
QA can be defined as an effort to find and overcome problems with quality, directing the performance and behaviors of practitioners and institutions toward more appropriate and acceptable health outcomes, expenditures, or both. The central QA question is reactive, “Are we doing a task/procedure the way it is supposed to be done?” QI activities are intended improve services or clinical care based on a known issue through a “plan, do, check, act” cycle. With this cycle, processes can be continuously revised and improved on the basis of the data derived from them. The central QI question is proactive, “How can we improve the way we do things?”.
In medical institutions, QA/QI is a necessary, integral part of hospital operations and is not subject to review as research, as defined under federal regulation. Rather, it is governed by Joint Commission and hospital standards. Human Subject Research (HSR) is governed by federal regulation, under IRB oversight. 2
- Implementing a new process or checklist in order to reduce pharmacy prescription error rates
- Implementing evidence-based interventions and collecting data on downstream effect on some facet of care or outcomes
- Improvement in patient and family comprehension of medication dosing though use of teach-back method
- Reduction of in-patient admissions and length of stay through use of a new discharge checklist
- Reduction of time in the ER through use of a new triaging method
- Reduction in costs of prescriptions by converting to generic medications
- compliance with guideline recommendations
- improvement of over-all quality of life
- reduction of morbidity and mortality
- improvement in patient and family understanding of disease or care plan
- reduction in in-patient admissions and length of stay
- reduction of ER visits
- reduction in costs of service
- comparing two or more accepted care practices
QA and QI consist of systematic, data-guided activities to bring about prompt positive changes in the delivery of health care and involve deliberate actions to improve care, typically at the institutional level. Introducing QA/QI methods often means encouraging people in the clinical care setting to use their daily experience to identify ways to improve care, implement changes on a small scale, collect data on the effects of those changes, and assess the results.4
References
- Carillion Clinic Institutional Review Board, Application to Determine if Project is Quality Assurance/Quality Improvement, August 2012, Roanoke VA.
- Stanford University HRPP, Quality Assessment and Quality Improvement (QA/QI) FAQs (pdf)
- Distinction: Human Subject Research – vs. – Quality Improvement, OASD(HA)/TMA, HRPP at Tricare, Human Research Protection Program, Falls Church, VA.
- Baily, MA, The Ethics of Using QI Methods to Improve Health Care Quality and Safety, A Hastings Center Special Report, July-August 2006, p. S5.