finding this money, noting the total amount is considerable once investments in technologies are included. The cost of improving quality must be considered in the context of financial realities, one speaker noted. Another speaker also recognized that the health care system is not value reimbursable, but is cost reimbursable, which provides little incentive for innovation. The bottom line was that evaluation should be a byproduct and an expected consequence of care. Marginal activities to conduct evaluations would be counterproductive in this sense. Although evaluation is not currently a byproduct of health care, it may not be far off, given the evolution of data systems.

Responding to a question about the role of private payers to recognize the costs of quality improvement, to manage innovation, and to ensure sustainability, one speaker identified innovative collaboration as key. One type of collaboration is the formation of partnerships with academic institutions to obtain data and subsequently perform studies on those data. Pay-for-performance initiatives were also mentioned as a method to provide incentives for quality improvement.

The last question asked during this session was about publication in peer-reviewed journals as the traditional vehicle for dissemination, recognizing that many nonacademic institutions do not publish articles. One speaker noted the difficulty in publishing articles if data are collected from multiple sites around the country because approval from multiple IRBs would need to be obtained. For the effort required to publish articles, given the questionable value added to nonacademic institutions, the marginal costs would likely be substantial. Peer-reviewed articles are successful vehicles for spread for those who write papers, but are not always useful to those from an operational context. Other methods participants noted for disseminating knowledge and ideas were the Institute for Healthcare Improvement’s annual meeting and the general media.



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