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Professionalism and Evolving Concepts of Quality

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For much of the twentieth century, quality of care was defined specifically in terms of physician characteristics and behaviors. High-quality physicians were well trained, knowledgeable, skillful, and compassionate. More recently, quality of care has been defined in terms of systems of care. High-quality organizations develop and adopt practices to reduce adverse events and optimize outcomes. This essay discusses this transformation from physician-based to organization-based concepts of quality and the consequences for patient care and medical professionalism.

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Acknowledgements

We thank Drs. David Bates, Paul Cleary, Gary Brandeis, and Robert Witzburg for their thoughtful comments on earlier drafts of this essay. Funding was supported by NIH/NIAMS K24 AR 02123 and NIH/NIAMS P60 AR 47782.

Potential Financial Conflicts of Interest

None disclosed.

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Correspondence to Jeffrey N. Katz MD, MS.

Appendix

Appendix

Methodology for review of the literature

Using the PubMed search engine, we utilized the keyword quality of care to identify articles on quality. We performed 3 separate searches for the periods 1966–1979, 1980–1994, and 1995–2000. Citations were excluded if they did not deal with quality of care, did not have an abstract, were not in English, or did not evaluate quality of care in the United States. Within each period, we reviewed randomly selected citations until we found 50 per period that were not excluded. To estimate the number of articles dealing with quality of care in each of the 3 periods, we multiplied the total number of citations (“hits”) by the ratio of eligible citations we reviewed to the total (eligible plus ineligible) that we reviewed, and then divided by the number of years in the period. (For example, in the period 1980–1994, quality of care generated 1,792 citations. We reviewed 108 randomly selected citations to identify 50 that were eligible. We estimate the number of citations in this period as \( 1792 \times {{\left( {{50} \mathord{\left/ {\vphantom {{50} {108}}} \right. \kern-\nulldelimiterspace} {108}} \right)}} \mathord{\left/ {\vphantom {{{\left( {{50} \mathord{\left/ {\vphantom {{50} {108}}} \right. \kern-\nulldelimiterspace} {108}} \right)}} {15\,{\text{years}} = }}} \right. \kern-\nulldelimiterspace} {15\,{\text{years}} = }55\,{\text{per}}\,{\text{year}} \).) We completed a detailed coding form on the abstracts of the 50 eligible citations per period. The coding form classified the abstract as addressing physician-centered aspects of quality (such as credentials, training, or volume) or systems-centered aspects of quality.

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Katz, J.N., Kessler, C.L., O’Connell, A. et al. Professionalism and Evolving Concepts of Quality. J GEN INTERN MED 22, 137–139 (2007). https://doi.org/10.1007/s11606-006-0031-1

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