title: When is it worth introducing a quality improvement program? A mathematical model.
abstract: Quality improvement programs must compete with other health care interventions for limited health care resources. The goal of the research presented here was to develop a model that portrays the mathematical relationship between the size of a quality deficit caused by the noncompliance of health professionals and the cost-effectiveness of a quality improvement program. The model allows the determination of the minimum size of a quality deficit for which it is worth introducing a quality improvement program. If a quality improvement program has already been implemented, the model can be used to define the quality threshold beyond which a reduction in quality becomes economically unattractive. An example considering the reduction of underuse in depression treatment demonstrates that an intervention with a favorable cost-effectiveness ratio may become economically unattractive once the costs for the implementation effort are considered.
authors.affiliation: Institut für Gesundheitsökonomie und Klinische Epidemiologie, Universität zu Köln, Köln, Germany. afschin.gandjour@medizin.uni-koeln.de
authors.forename: Afschin
authors.initials: A
authors.lastname: Gandjour
authors.forename: Karl Wilhelm
authors.initials: KW
authors.lastname: Lauterbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000639:Amitriptyline / Q000191:economics / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000191:economics / Q000627:therapeutic use; D019985:Benchmarking; D015283:Citalopram / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003866:Depressive Disorder / Q000188:drug therapy; D005858:Germany; D019983:Guideline Adherence / Q000191:economics*; D006801:Humans; D017059:Models, Econometric; D011785:Quality Assurance, Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics / Q000627:therapeutic use
chemical_list: D000639:Amitriptyline; D000929:Antidepressive Agents, Tricyclic; D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors