Abstract:
:Clinicians can use data to improve daily clinical practice. This paper offers eight principles for using data to support improvement in busy clinical settings: 1) seek usefulness, not perfection, in the measurement; 2) use a balanced set of process, outcome, and cost measures; 3) keep measurement simple (think big, but start small); 4) use qualitative and quantitative data; 5) write down the operational definitions of measures; 6) measure small, representative samples; 7) build measurement into daily work; and 8) develop a measurement team. The following approaches to using data for improvement are recommended. First, begin with curiosity about outcomes or a need to improve results. Second, try to avoid knee-jerk, obstructive criticism of proposed measurements. Instead, propose solutions that are practical, goal-oriented, and good enough to start with. Third, gather baseline data on a small sample and check the findings. Fourth, try to change and improve the delivery process while gathering data. Fifth, plot results over time and analyze them by using a control chart or other graphical method. Sixth, refine your understanding of variation in processes and outcomes by dividing patients into clinically homogeneous subgroups (stratification) and analyzing the results separately for each subgroup. Finally, make further changes while measuring key outcomes over time. Measurement and improvement are intertwined; it is impossible to make improvements without measurement. Measuring and learning from each patient and using the information gleaned to test improvements can become part of daily medical practice in local settings.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Nelson EC,Splaine ME,Batalden PB,Plume SKdoi
10.7326/0003-4819-128-6-199803150-00007subject
Has Abstractpub_date
1998-03-15 00:00:00pages
460-6issue
6eissn
0003-4819issn
1539-3704journal_volume
128pub_type
杂志文章abstract::Folate deficiency is a frequent cause of anemia in alcoholics, but little attention has been paid to its prevention. Folic acid was readily soluble in wines of high ethanol content at concentrations of 10 microgram/ml. Lactobacillus casei folate activity of folic acid added to wines was well maintained during a month'...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-87-5-542
更新日期:1977-11-01 00:00:00
abstract::Three patients with advanced Graves' ophthalmopathy were treated with cyclophosphamide. All had proptosis and diplopia. One patient had disabling iatrogenic Cushing's syndrome from steroid treatment of the ophthalmopathy and had undergone bilateral orbital decompression before cyclophosphamide therapy; steroids could ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-90-6-921
更新日期:1979-06-01 00:00:00
abstract:Background:Acute pancreatitis (AP) varies in severity, prompting development of systems aimed at predicting prognosis to help guide therapy. Although several prediction approaches are available, their test characteristics and clinical utility are not completely understood. Purpose:To evaluate the test characteristics ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/M16-0650
更新日期:2016-10-04 00:00:00
abstract::Identical male twins had alveolar cell carcinoma with nearly synchronous onset and similar histopathologic features, both metastatic to the brain. The hypothesis is advanced that there are genes shared by these twins that determine not only the susceptibility of pulmonary cells to malignant transformation but also the...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-87-4-447
更新日期:1977-10-01 00:00:00
abstract::Bioethics has become a common course of study in medical schools, other health professional schools, and graduate and undergraduate programs. An analysis of past ethical scandals, as well as the bioethics apparatus that emerged in response to them, is often central to the discussion of bioethical questions. This histo...
journal_title:Annals of internal medicine
pub_type: 历史文章,杂志文章
doi:10.7326/M15-2642
更新日期:2016-04-19 00:00:00
abstract:BACKGROUND:Pretreatment antimicrobial resistance has an important impact on the efficacy of many Helicobacter pylori treatment regimens. OBJECTIVE:To estimate the prevalence of H. pylori resistance to antimicrobials in the United States, to characterize risk factors associated with H. pylori antimicrobial resistance, ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析
doi:10.7326/0003-4819-136-1-200201010-00008
更新日期:2002-01-01 00:00:00
abstract:BACKGROUND:A daily injection of low-molecular-weight heparin (LMWH) is often prescribed to women with unexplained recurrent pregnancy loss (RPL), although evidence suggesting a benefit is questionable. OBJECTIVE:To determine whether LMWH increases ongoing pregnancy and live-birth rates in women with unexplained RPL. ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.7326/M14-2062
更新日期:2015-05-05 00:00:00
abstract::Cataract disrupts the crystalline lens, a transparent, elastic, avascular, biconvex structure composed of a capsule, lens epithelium, and lens fiber cells. Many factors contribute to the progression of lens opacity, but aging is most frequently associated with cataract. As aging-related cataract develops, many biochem...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-102-1-82
更新日期:1985-01-01 00:00:00
abstract:BACKGROUND:Patients with chronic obstructive pulmonary disease (COPD) frequently develop exacerbations, leading to major clinical and health resource use ramifications. OBJECTIVE:To prospectively evaluate the effectiveness of a long-acting inhaled anticholinergic bronchodilator, tiotropium, in reducing COPD exacerbati...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-143-5-200509060-00007
更新日期:2005-09-06 00:00:00
abstract::The coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a series of workshops during whi...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-150-7-200904070-00115
更新日期:2009-04-07 00:00:00
abstract::Reversible cerebral vasoconstriction syndromes (RCVS) comprise a group of diverse conditions, all characterized by reversible multifocal narrowing of the cerebral arteries heralded by sudden (thunderclap), severe headaches with or without associated neurologic deficits. Reversible cerebral vasoconstriction syndromes a...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-146-1-200701020-00007
更新日期:2007-01-02 00:00:00
abstract:BACKGROUND:The news media are often criticized for exaggerated coverage of weak science. Press releases, a source of information for many journalists, might be a source of those exaggerations. OBJECTIVE:To characterize research press releases from academic medical centers. DESIGN:Content analysis. SETTING:Press rele...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-150-9-200905050-00007
更新日期:2009-05-05 00:00:00
abstract:BACKGROUND:Although the efficacy of adjuvant chemotherapy in prolonging survival for women with breast cancer has been well documented, limited population-based information is available on the actual use of chemotherapy. OBJECTIVE:To examine the relationship between age and chemotherapy use. DESIGN:Cohort study. SET...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-138-2-200301210-00009
更新日期:2003-01-21 00:00:00
abstract:OBJECTIVE:To assess the effectiveness of housestaff physician reporting as a method for identifying adverse events on a medical service and to compare the physician reporting mechanism with a retrospective record review mechanism. SETTING:Medical service of an urban, university-affiliated teaching hospital. DESIGN:Co...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-119-5-199309010-00004
更新日期:1993-09-01 00:00:00
abstract::Gentamicin and tobramycin were compared for cost effectiveness in the treatment of adult patients with serious infections in a general medical service. We used data from a randomized double-blind trial in which the only observed difference between the clinical effects of these aminoglycosides was the incidence of neph...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-101-6-764
更新日期:1984-12-01 00:00:00
abstract::Neuropathologic and neurochemical studies of older adults with Down's syndrome and those with Alzheimer's disease reveal striking similarities. Genetic studies indicate that near relatives of patients with Alzheimer's disease are at increased risk of developing Alzheimer's disease, and the risk appears to be age speci...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-103-4-566
更新日期:1985-10-01 00:00:00
abstract:BACKGROUND:The sequelae during the first two decades after acute hepatitis C virus (HCV) infection have been well studied, but the outcome thereafter is unknown. OBJECTIVE:To conduct an extended study of the natural history of HCV infection by using archived serum specimens originally collected between 1948 and 1954. ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-132-2-200001180-00003
更新日期:2000-01-18 00:00:00
abstract:PURPOSE:To evaluate the possibility that fibrinogen represents a cardiovascular risk factor. DATA IDENTIFICATION:A computerized literature search (1980 to 1992) identified all published epidemiologic studies on fibrinogen and cardiovascular disease. Clinical and basic research data were found by separate searches. Ref...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析
doi:10.7326/0003-4819-118-12-199306150-00008
更新日期:1993-06-15 00:00:00
abstract:BACKGROUND:The established International Prognostic Index for lymphomas has not included patients with systemic AIDS-related non-Hodgkin lymphoma. OBJECTIVE:To establish the most appropriate prognostic index for use in patients with systemic AIDS-related non-Hodgkin lymphoma. DESIGN:A prospective study involving univ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-143-4-200508160-00007
更新日期:2005-08-16 00:00:00
abstract:BACKGROUND:Elevated blood pressure (BP) is the largest contributing risk factor to all-cause and cardiovascular mortality. PURPOSE:To update a systematic review on the benefits and harms of screening for high BP in adults and to summarize evidence on rescreening intervals and diagnostic and predictive accuracy of diff...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/M14-1539
更新日期:2015-02-03 00:00:00
abstract:BACKGROUND:The risk for venous thromboembolism during pregnancy or postpartum is uncertain. OBJECTIVES:To estimate the relative and absolute risk for deep venous thrombosis and pulmonary embolism during pregnancy and postpartum and to describe trends in incidence. DESIGN:Population-based inception cohort study using ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-143-10-200511150-00006
更新日期:2005-11-15 00:00:00
abstract:BACKGROUND:Travelers' diarrhea causes substantial morbidity and postinfectious irritable bowel syndrome. OBJECTIVE:To evaluate nonabsorbable rifaximin for prevention of travelers' diarrhea. DESIGN:Randomized, double-blind, placebo-controlled clinical trial. SETTING:Guadalajara, Mexico. PARTICIPANTS:U.S. students. ...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-142-10-200505170-00005
更新日期:2005-05-17 00:00:00
abstract:BACKGROUND:Initiation of antiretroviral therapy (ART) during tuberculosis (TB) treatment remains challenging. PURPOSE:To assess evidence from randomized, controlled trials of the timing of ART initiation in HIV-infected adults with newly diagnosed pulmonary TB. DATA SOURCES:PubMed, EMBASE, Cochrane Central Register o...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析,评审
doi:10.7326/M14-2979
更新日期:2015-07-07 00:00:00
abstract:OBJECTIVE:To determine whether a statistical association exists between "low-count" bacteriuria (> 10(2) to 10(4) colony-forming units/mL) and acute urinary symptoms in young women. DESIGN:Prospective, case-control study. SETTING:Gynecology clinic at a student health center. PATIENTS:Women with or without urinary or...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-119-6-199309150-00002
更新日期:1993-09-15 00:00:00
abstract:BACKGROUND:Apolipoprotein E (apoE) genotypes play critical roles in lipid metabolism and are believed to influence risk for coronary heart disease (CHD). Despite many population studies, however, the impact of apoE polymorphism on risk for CHD remains uncertain. PURPOSE:To qualitatively and quantitatively assess the e...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析
doi:10.7326/0003-4819-141-2-200407200-00013
更新日期:2004-07-20 00:00:00
abstract::The latest guidelines from the American College of Cardiology and American Heart Association, released in fall 2013, provide a long-anticipated update to the recommendations of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/M16-1739
更新日期:2016-12-06 00:00:00
abstract:DESCRIPTION:Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for bladder cancer. METHODS:The USPSTF performed a targeted literature search for new evidence on the benefits and harms of screening, the accuracy of primary care-feasible screening tests, and the benefit...
journal_title:Annals of internal medicine
pub_type: 杂志文章,实务指引
doi:10.7326/0003-4819-155-4-201108160-00008
更新日期:2011-08-16 00:00:00
abstract::We performed selective venous catheterization and sampling for ACTH in six patients with ACTH-secreting pituitary adenomas (Cushing's disease) and four patients with occult ectopic ACTH-secreting neoplasms. In five patients with Cushing's disease in whom the inferior petrosal sinus could be catheterized, ACTH levels w...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-94-5-647
更新日期:1981-05-01 00:00:00
abstract:OBJECTIVE:To document the effects of treatment with famciclovir on the acute signs and symptoms of herpes zoster and postherpetic neuralgia. DESIGN:A randomized, double-blind, placebo-controlled, multicenter trial. SETTING:36 centers in the United States, Canada, and Australia. PATIENTS:419 immunocompetent adults wi...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-123-2-199507150-00002
更新日期:1995-07-15 00:00:00
abstract::During 1973 and 1974, we looked for cases of Colorado tick fever throughout Colorado; 228 cases were identified. Although 90% of the patients reported exposure to ticks before illness, only 52% were aware of an actual tick bite. Typical symptoms of fever, myalgia, and headache were common, but gastrointestinal symptom...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-88-3-303
更新日期:1978-03-01 00:00:00