Effectiveness of internal quality assurance programmes in improving clinical practice and reducing costs

Abstract

RATIONALE, AIMS AND OBJECTIVES: To assess the effectiveness of internal initiatives to improve quality as compared with external feedback, and as compared with a control group. METHOD: Ten primary health centres were randomly selected from the centres in the Murcia's Region and were randomly assigned into three groups: G1 committed themselves to the improvement; G2 composed by two subgroups: with and without quality improvement (QI) activities - received external feedback; G3 received no intervention. Quality of common cold management was measured in a random sample of 50 patients per centre before and after interventions. Effect was assessed comparing criteria compliance and the cost of treatments for common cold in the three groups. RESULTS: G1 and G2 subgroup with internal QI improved significantly in all criteria, and in G1 average treatment cost decreased by 60% (P < 0.01). G3 improved only in one criterion. Estimated yearly savings in treatment costs for common cold, for a centre with internal QI, were euro 12,193.83 and it would be euro 1,817 004.65 for the 30 centres in the Region. CONCLUSIONS: Internally assumed QI activities were significantly more effective than external feedback. Besides, the high cost of deficient quality provides a wide margin to invest with benefits in the promotion of internal QI programmes.