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Plan-Do-Study-Act cycle — USMLE Step 3 MCQ

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HardEthics, Patient Safety, Quality Improvement, Systems-Based PracticePlan-Do-Study-Act cycleUSMLE Step 3

A clinic adds automatic text reminders to reduce missed anticoagulation visits. Attendance improves from 68% to 82%. Which additional measure is the best balancing measure?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Percentage of patients reporting opt-out or confidentiality concerns after reminders

The best answer is “Percentage of patients reporting opt-out or confidentiality concerns after reminders”. A balancing measure detects unintended harm caused by the intervention. Opt-outs and confidentiality complaints reveal a tradeoff, whereas attendance is the outcome and delivery or activation are process measures. This distinction prevents an apparent improvement from concealing a new patient-level harm created by the intervention.

Reference: Institute for Healthcare Improvement: Model for Improvement — Establishing Measures: https://www.ihi.org/library/model-for-improvement/establishing-measures