Research and development in quality of care: establishing the research agenda.

Features of research into quality of care Research and development in quality of care and quality improvement are closely linked to clinical research and research on health services, and so should not be characterised by specific research methodology, but primarily by research questions.These are derived from continuously assuring and improving the quality of patients' care.The aim of all parties in health care is that patients receive good or optimal care.Their views on good clinical practice may, however, differ.Professionals will emphasise the clinical effectiveness of their actions and good health outcomes; patients wish a friendly attitude in care providers, good information on their illness, and easy access to health services; whereas health authorities will stress efficiency and cost effective care.So, good quality of care includes a variety of aspects.To deliver and ensure such care, specific measures are necessary to systematically and continuously evaluate and enhance the quality of care.This I shall call quality improvement.Quality improvement includes a variety of mutually related activities, such as tracing problems, developing guidelines, criteria, protocols, or targets for good clinical practice, reviewing actual performance, changing care when necessary, and creating the conditions for improving clinical practice.Good clinical practice is a dynamic concept, which is continuously fed and supported by research and development (fig 1).On the one hand this refers to research on health and illness (study of the aetiology, incidence, prevalence, course, diagnosis, prevention, and treatment of diseases and symptoms).Input particularly comes through studies of clinical research and health technology which provide evidence on valuable procedures for diagnosis, treatment, and prevention.These may not only include the efficacy ofthe procedures, but also their safety, costs, ethical aspects, or social implications.Clinical practice is influenced on the other hand by research on health services.This is defined as: "a multidisciplinary field of inquiry, both basic and applied, that examines the use, costs, quality, accessibility, delivery, organisation, financing and outcomes of health care services and effects of health services for individuals and populations".3So, this includes research on the actual quality of care and factors influencing the quality of care positively or negatively.Both research on good clinical practice and research on the quality of health services provide a major input for research and development in quality improvement (fig 1).Research on the quality of healthcare attempts to provide scientific support for actual activities that improve quality.It studies which methods, tools, approaches, instruments, and programmes are most cost effective, feasible, and acceptable for assessing and improving the quality of patient care.Clinical research or studies on health technology may show the effects and costs of a new inhaler on lung func- tion and the quality of life of patients with asthma.Research on health services may study the actual use of this medication and variation in prescribing between practitioners.Research on quality of care and quality improvement may focus on translating the evidence from clinical research into a feasible guideline, or into quality indicators, or devising a method to collect reliable data on the quality of asthma