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Medical Decision Making
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When Is It Worth Introducing a Quality Improvement Program? A Mathematical Model

Afschin Gandjour, MD, PhD

Institut for Gesundheits konomie und Klinische Epidemiologie, Universitt zu Kln, Gleueler Strae 176-178, 50935 Kln, Germany; telephone: 49-(0)221-46867-20; fax: 49-(0)221-46867-10; afschin.gandjour{at}medizin.uni-koeln.de

Karl Wilhelm Lauterbach, MD, DSc

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 introducinga 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 consideringthe 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.

Key Words: quality problem • quality • improvement program • cost-effectiveness

Medical Decision Making, Vol. 23, No. 6, 518-525 (2003)
DOI: 10.1177/0272989X03258441
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