title: Effectiveness of internal quality assurance programmes in improving clinical practice and reducing costs.
abstract: OBJECTIVE
  To assess the effectiveness of internal initiatives to improve quality as compared with external feedback, and as compared with a control group.
  
  
  METHODS
  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.
authors.affiliation: Department of Public Health, School of Medicine, University of Murcia, Murcia, Spain. gasconjj@um.es
authors.forename: Juan J Gascón
authors.initials: JJ
authors.lastname: Cánovas
authors.forename: Pedro J Saturno
authors.initials: PJ
authors.lastname: Hernández
authors.forename: Jose J Antón
authors.initials: JJ
authors.lastname: Botella
mesh_terms: D003139:Common Cold / Q000188:drug therapy; D003363:Cost Control; D017048:Health Care Costs; D006801:Humans; D011320:Primary Health Care / Q000191:economics* / Q000592:standards*; D015397:Program Evaluation / Q000379:methods*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D015203:Reproducibility of Results