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Knowledge Matters

Eric S. Holmboe, MD; Rebecca Lipner, PhD; Ann Greiner, MCP

JAMA. 2008;299(3):338-340.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Significant quality-of-care gaps are well documented in the United States.^1-2 These reports have focused mostly on underuse of performance measures of important processes of care, and some outcomes of care.¹ Others have argued that the cause of underuse of these evidence-based processes of care is usually not deficient physician knowledge about whether to perform the examination or order the test, but rather poorly designed, dysfunctional microsystems of care unable to deliver effective, efficient, and reliable care.^3-4

Consequently, much of the recent work in quality improvement has focused on changing microsystems of care "to deliver the right care for the right patient at the right time, all the time."⁵ What is often overlooked in quality improvement, but equally important, is that effective microsystems must have highly competent clinicians, who possess sufficient knowledge and clinical skills to make and execute evidence-based decisions, . . . [Full Text of this Article]

Medical Knowledge and Quality

Author Affiliations: American Board of Internal Medicine, Philadelphia, Pennsylvania.

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