When is it worth introducing a quality improvement program? A mathematical model

Med Decis Making. 2003 Nov-Dec;23(6):518-25. doi: 10.1177/0272989X03258441.


Quality improvement programs must compete with other health care interventions for limited health care resources. The goal of the research presented here was to develop a model that portrays the mathematical relationship between the size of a quality deficit caused by the noncompliance of health professionals and the cost-effectiveness of a quality improvement program. The model allows the determination of the minimum size of a quality deficit for which it is worth introducing a quality improvement program. If a quality improvement program has already been implemented, the model can be used to define the quality threshold beyond which a reduction in quality becomes economically unattractive. An example considering the reduction of underuse in depression treatment demonstrates that an intervention with a favorable cost-effectiveness ratio may become economically unattractive once the costs for the implementation effort are considered.

MeSH terms

  • Adolescent
  • Adult
  • Amitriptyline / economics
  • Amitriptyline / therapeutic use
  • Antidepressive Agents, Tricyclic / economics
  • Antidepressive Agents, Tricyclic / therapeutic use
  • Benchmarking
  • Citalopram / economics
  • Citalopram / therapeutic use
  • Cost-Benefit Analysis
  • Decision Support Techniques*
  • Depressive Disorder / drug therapy
  • Germany
  • Guideline Adherence / economics*
  • Humans
  • Models, Econometric*
  • Quality Assurance, Health Care / economics*
  • Quality-Adjusted Life Years
  • Selective Serotonin Reuptake Inhibitors / economics
  • Selective Serotonin Reuptake Inhibitors / therapeutic use


  • Antidepressive Agents, Tricyclic
  • Serotonin Uptake Inhibitors
  • Citalopram
  • Amitriptyline