How to Make Systems Changes
for Improved Care

Establish Goals for Improvement

The goal of health care quality improvement is to eliminate the gap between current and optimal clinical performance. A first overall goal could be to design a system of care to support providers' efforts to practice in accordance with evidence-based standards of care -- to achieve in clinical practice, the effectiveness of interventions that are known to be efficacious in clinical trials.

Other goals will be based on reducing gaps identified by the assessment of the practice or care system. For example, "increase the proportion of adults with diabetes and high blood pressure who are taking action -- losing weight, increasing physical activity, or reducing sodium intake -- to help control their blood pressure."

Healthy People 2010 lists national goals for the next decade, many of which relate to diabetes, blood pressure, cholesterol, obesity, nutrition and physical activity (to link to specific goals see resources). For example, 3 goals for diabetes are:

5-4. Increase the proportion of adults with diabetes whose condition has been diagnosed. Target: From 68 to 80 percent.

5-1. Increase the proportion of persons with diabetes who receive formal diabetes education. Target: From 45 to 60 percent.

5-12. Increase the proportion of adults with diabetes who have an A1C measurement at least once a year. Target: From 24 to 50 percent.

To achieve any chosen goal, a practice, provider, or planning group would need to determine baseline measures and an achievable target, then select and implement a number of small steps or objectives that would lead to achievement of the goal over time.

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