What If? How incorporating basic, clinical and translational medical research into quality measures will restore and shape healthcare for the better.

Quality measures are a significant part of health, industry and the future. From government reimbursement and oversight to public reporting, quality measures shape the United States’ healthcare system. Measurements will continue to be of debate with evidence-based approaches replacing standards no longer considered best practice.

As quality and measurements continue to be reshaped as well as integrate within health disciplines, it is paramount that medical and clinical research is included.

Going back in time we see that quality measurements and standards benefit both the public and private industry.

Why take quality measurements to the public? To build trust and transparency, to show accountability, to encourage hospital and healthcare safety and to promote those above average. Quality measurements benefit private industry in terms of publicity and public appeal, undoubtedly.

Quality and patient safety credentialing and specialties are a business. Their education and certification requirements for personnel as well as in certification of health facilities are profitable and desirable. Several large companies, including the Joint Commission and the National Committee for Quality Assurance, provide accreditation and “seals” that recognize healthcare facilities for quality in healthcare. Government and non-profit agencies provide regular surveys and quality reviews as part of standards of oversight, including through Centers for Medicare and Medicare as well as other Department of Health and Human Services, such as the Agency for Healthcare Quality and Research (AHRQ). Additionally, membership organizations like the National Quality Forum provide healthcare industry education, service delivery research and membership association benefits.

While some measurements and standards are debated over, in regards to cost-effectiveness or evidence basis, one thing is clear: healthcare safety and quality is improving nationally in many ways.

In order to effectively drive comprehensive and total quality in health, however, it is time to incorporate medical and clinical research into quality accreditation. Often in Joint Commission surveys or in government agency onsite reviews, standards are dictated and draconian. Some measurements and standards are well documented in evidence, but others are extremely subjective, having been decided by a select few without transparent rationale. Additionally, quality agencies such as AHRQ perform research on healthcare services (delivery, quality of care) but often do not account for variables in clinical research.

Of the numerous healthcare organizations and associations I have been a part of, including infection prevention, patient safety, public health and care coordination for the underserved, I have yet to experience any measurements that consider academic medicine, clinical research or basic medical research. Clinical and basic research is not factored into the equation, though it is a significant factor in the United States healthcare.

The medical, clinical and basic research system has potential to be reshaped and grow nationally and internationally through strategic planning. Incorporation of private and public partnerships as well as academic medical center expansion and collaborations can drive medical research to become a systematic, transparent and publicly trusted branch of healthcare. Quality forums and agencies must recognize and reshape their standards to incorporate this new vision: not only for institutions to meet the standards but so that the agencies can help drive change.

• Instead of surveying patients and ensuring they had education on expectations during care, why not incorporate a standard to ensure they have been educated and offered current clinical trials?
• Instead of ensuring the facility meets structure design that may or may not be evidence-based, why not initiate new standards that incorporate facility accommodations for medical and basic research?
• Rather than just randomly interviewing employees to ensure responses match all policy and procedures for medication delivery protocols, why not ask questions on whether patients were connected to academic research in timely and appropriate methods?
• Rather than just reviewing staff to patient ratios, why not initiate standards relatable to academic medicine and researchers: patient ratios and academic teaching versus clinician resource dedication?
• In chart reviews, instead of only assuring reimbursement and diagnosis coding accuracy, why not assure insurance coverage versus research company donation for clinical trial participation?

Transparency in decisions around quality standards, as well as transparency in those deciding them, have only just begun. Transparency in public quality reporting is in its infancy. Transparency with medical research is absolutely needed in order to build public trust. It is time to incorporate all in order to assure true quality in healthcare. Medical research is quality in healthcare, and national quality organizations are in prime position to lead this understanding, alongside hospital and insurance industries. Additionally, academic medicine and professor input is crucial. Conversations including academic medicine as well as decisions shaped by their input will only further the partnership in quality and clinical care.

Medical research is part of quality in healthcare. In fact, clinical and basic research shape quality in healthcare. It is time to include medical research are part of our quality standards, measurement and reporting.