Every year large quantities of research evidence on the effectiveness of specific medical interventions and health care innovations is published. This literature does not automatically lead to improvements in patient care. Unwarranted inter-doctor variation, that has been documented since the 1940s, continues to persist in many health care settings. Systematic implementation efforts are needed to achieve and sustain a high level quality of care.

Quality of health care
Quality of health care, with regard to definition, measurement and improvement, is the central focus of this programme. Clinical practice guidelines, including validated quality indicators, are seen as a first choice strategy in this field. The development of guidelines is a challenge; in a consensus procedure, evidence-based information regarding effectiveness, efficiency, patient preferences, and safety has to be appraised, and subsequently related to national or local experiences on best practices to assure feasibility, timeliness and equity. Research is, therefore, needed on the preferred methods for development of multidisciplinary guidelines and indicators, taking into account the different perspectives of the stakeholders, including the collective perspective of patients.

Not simply disseminating guidelines
It is well known that simply disseminating guidelines does not lead to significant improvements in the quality of care. Therefore, we also study determinants of variation in quality of care and of successful implementation strategies. Special attention is paid to the micro-level of health care, the interaction between professionals and patients, when physicians may experience a conflict between the adherence to guidelines (with population-based recommendations) and patient-centred work (applying the guidelines to unique patients). Health care should be delivered according to accepted professional guidelines, with specific benchmarks for the quality indicators. However, health care delivery should also meet objective and subjective needs of individual patients towards the medical interventions and related aspects, such as self-management. Patients should be well-informed and invited to share decision making in case of preference-sensitive decisions.

Programme objectives:

• To study appropriate methods for the development of clinical practice guidelines and indicators;
• To study determinants of variation in the quality of professionals’ performance; these determinants may be related to the guidelines, the professionals, their colleagues, the patients, and the meso- and macroorganisation of health care;
• To study the (cost) effectiveness of implementation strategies to improve quality of care.