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American Journal of Medical Quality
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Quality Improvement in Family Practice: A Recipe for Change

Stephen Elgert, MD

Dartmouth Family Practice Residency-Concord Division, Concord, NH, Selgert{at}crhc.org

A new recipe is presented, splitting quality improvement into 4 levels. The Q1 level corresponds to the everyday processes that guide our daily work flow. Q2 corresponds to commonly thought of outcome measures such as HEDIS criteria. Q3 relates to the executive functions that permit seasoned clinicians to draw generalizations about care for individual patients by synthesizing large amounts of data from both psychosocial as well as classical history/physical sources. Finally Q4 reflects more population-based quality improvement activities. Examples are given for each. Each of these levels requires a different approach for improvement activities. Each must be seen in the context of an expanded "quality compass" and in the paradigm of the PLAN-DO-CHECK-ACT cycle of quality improvement. Finally, a practical application of how this could be instituted at a Family Practice residency is given.

Key Words: Family practice • quality improvement

American Journal of Medical Quality, Vol. 19, No. 2, 83-87 (2004)
DOI: 10.1177/106286060401900206
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