Crossing the Global Health Care Quality Chasm

Abstract

Despite years of investment and research, the quality of health care in every country is much worse than it should be. Problems range from disrespect of people when they are interacting with the health care system, to preventable mistakes and harm, to high rates of incorrect and ineffective treatment.Among low-and middle-income countries (LMICs) the exact burden of poor quality is difficult to quantify because of a dearth of data, lack of standard metrics, and insufficient research on quality interventions. But new estimates suggest that globally between 5.7 and 8.4 million people die every year from poor-quality care in LMICs. 1 These deaths, plus disabilities from poorquality care, account for lost productivity totaling an estimated $1.4 trillion to $1.6 trillion dollars annually. 1 Wealthier countries have similar experiences in terms of death, disability, and needless cost due to fragmented care, waste, and care organized around facilities instead of patients. One estimate suggests that 15% of all hospital costs in Organisation for Economic Co-operation and Development (OECD) countries can be attributed to patient harms from adverse events. 2 In 2001, the Institute of Medicine published a landmark report on the quality of US health care: Crossing the Quality Chasm: A New Health System for the 21st Century. The report starkly documented major defects in 6 dimensions of quality: safety, effectiveness, patientcenteredness, timeliness, efficiency, and equity. In the nearly 2 decades since, reports have demonstrated that many defects persist and that the "quality chasm" is global.TheNationalAcademiesofSciences,Engineering,and Medicine (NASEM) has issued another report on global health care quality, with an emphasis on low-resource settings: Crossing the Global Quality Chasm: Improving Health CareWorldwide.Thecommitteeincludedscholarsandleadersfromnationsacrossthespectrumofwealth. 1 Thisreport joins 2 recent analyses of problems in global health care quality. 3 Thereportstatesthatwithoutcorrectionofdefects in health care quality, especially in LMICs, universal health coverage, a key component of WHO's Sustainable Development Goals, 4 will give many people access to care that will not help them and may even be harmful.Yet there is reason for hope: momentum and commitment by the global community to achieve universal health coverage offer an opportunity for nations to improve the quality of care while they broaden access. But this will not happen automatically; so far, many nations seem to be focused on expanding access only. Equity and quality of care will arrive together, or not at all.

Adoption of a Personal Health Record in the Digital Age: Cross-Sectional Study

“…The eHealth movement, which is the delivery of health services and information through the internet or related technology, has been broadly promoted to improve the health status of patients [3,4]. Patient-facing tools have been endorsed by the Institute of Medicine and the World Health Organization to encourage patient-and person-centered care by facilitating patient involvement in medical decision-making [5,6]. The use of digital information for disease and health-related tracking is widespread and considered an "essential and important element in the health care sector" [7].…”

“…Engaged patients monitor and update their medication and there is potentially more treatment concordance, leading to positive health outcomes [17,19]. Patient engagement is increasingly recognized as a vital component of safe, person-centered care [6]. Providing patients with access to their EHRs through a PHR is a method for health care systems to promote engagement [20].…”

Care Around Birth Approach: A Training, Mentoring, and Quality Improvement Model to Optimize Intrapartum and Immediate Postpartum Quality of Care in India

“…With the global transition to the Sustainable Development Goals framework, multiple efforts have been undertaken for improving and optimizing the quality of care across the health care delivery system. 1,22,[26][27][28][29] The Care Around Birth approach adds to the existing body of evidence by potentiating efforts to improve the quality of health care delivery systems using a training, mentoring, and QI model in resource-constrained and poor-performing districts in India.…”

“…With the global transition to the Sustainable Development Goals framework, multiple efforts have been undertaken for improving and optimizing the quality of care across the health care delivery system. 1 , 22 , 26 – 29 …”

Models of care for patients with knee osteoarthritis in primary healthcare: a scoping review protocol

“…8 9 Although TKA is considered to be a cost-effective intervention, 10 patient-reported outcomes highlight its shortcomings. Evidence reveals that 5% of patients report postoperative complications, 11 50% report adverse events in the first year after surgery, 12 20%-34% report dissatisfaction with surgery, 13 and 3%-5% need surgery revision in less than 10 years. 14 Furthermore, the mortality rate associated with TKA is approximately 0.2%-0.37%.…”