Quality
"Quality is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." Institute of Medicine, McGlynn, 1997 |
Crossing the Quality Chasm
"In 2002, the Institute of Medicine published Crossing the Quality Chasm, an influential book that framed all future discussions of quality health care. Crossing came on the heels of the IOM publication To Err Is Human (2000) and a Journal of the American Medical Association report (1998) that warned of "serious and widespread quality problems...throughout American medicine." The report called attention to three broad categories of quality defects:
To Err Is Human estimated that as many as 98,000 people dies each year in hospitals from injuries or illness contracted during care.
In Crossing, the IOM outlined six specific aims (explained by Dr. Donald Berwick in the video above) that a health care system system must fulfill to deliver quality care:
Recognizing that aims must be accompanied by observable metrics, the IOM defined sets of measurements for each aim. For example:
Of course, this is all easier said than done. Hospitals could more easily follow evidence-based practices were there a national outcomes data base that provided population-based information. Effecting efficiency programs can mean a complete redesign of institutional culture, as in Virginia Mason's (Seattle) 20-year commitment to Lean management principles. Equitable care is unlikely without a sea change in national health policy (not that there is one) that extends well beyond the limitations of the Affordable Care Act.
The most encouraging developments in the industry-wide reassessment of quality are the recognition that safety and efficiency need not be mutually exclusive, an increased capacity for the practice of evidence-based medicine, and a new emphasis on patients when it comes to setting goals and measuring results."
Source: The Healthcare Quality Book (2nd edition), edited by Elizabeth R. Ransom, Maulik S. Joshi, David B. Nash, and Scott B. Ransom. |
The Donabedian Model
In health services we often use the model of Avis Donabedian to conceptualiz and evaluate quality in health care. The model proposes that structure, process, and outcomes are closely linked and determine outcome.
- Structure refers to the manner in which care is delivered, including facilities, equipment, and human resources.
- Process refers to all of the interactions between patients and providers, including diagnoses, treatments, preventive care, and patient education.
- Outcomes are all of the effects of health care on health status of patients and populations, including changes in health status, behavior, knowledge, satisfaction, and uality of life.