I know, I know...this is not the highest impact journal you've ever seen. But, guess what, good stuff can be found all over the literature...and here's one now.
This interesting work nicely highlights an important point: it's one thing to say we have quality issues in US healthcare, and it's quite another to have some common ground on how we approach those issues.
Bottom line, as the article highlights, is this: until we have a common framework about what exactly quality means in healthcare, it's going to be very difficult to make any improvement.
As for me, I generally use a Bayes' Theorem framework to decide how much testing is rational when it comes to questions of over or under-testing...but this article says I may need to use a different framework at different times.
Take a look at the article. What about you? Where do you fall and which framework do you use?
In this paper, we address the issue of overuse or underuse of health care interventions from the perspective of rational choice theory. We show that what is considered rational under one decision theory may not be considered rational under a different theory. We posit that the questions and concerns regarding both underuse and overuse have to be addressed within a specific theoretical framework. The applicable rationality criterion, and thus the “appropriateness” of health care delivery choices, depends on theory selection that is appropriate to specific clinical situations. We provide a number of illustrations showing how the choice of theoretical framework influences both our policy and individual decision making. We also highlight the practical implications of our analysis for the current efforts to measure the quality of care and link such measurements to the financing of health care services.