Quality in health care

The connection between generating new knowledge in medical research and putting that knowledge to use in medical practice is remarkably tenuous. In order to ensure and improve the quality of health care, the health care system apparently needs better ways to integrate the lessons of research into the routine activities of care. Recent investigations have focused on the degree to which physicians accept and apply new findings and on the methods by which health care organizations support the integration of new knowledge into routine care. Several research groups have illustrated how wide the gap is between technically possible quality and the quality actually achieved at the front line of medicine. In the Harvard Medical Practice Study,¹⁻³for example, investigators reviewed 30 000 randomly selected records from acute care hospitals and found that adverse events (injuries caused by medical management that prolonged hospitalization or produced disability at the time of