Defining high quality health care

Abstract

Most health care quality improvement efforts target measures of health care structures, processes, and/or outcomes. Structural measures examine relatively fixed aspects of health care delivery such as physical plant and human resources. Process measures, the focus of the largest proportion of quality improvement efforts, assess specific transactions in clinical-patient encounters, such as use of appropriate surgical antibiotic prophylaxis, which are expected to improve outcomes. Outcome measures, which comprise quality of life endpoints as well as morbidity and mortality, are of greatest interest to clinicians and patients, but entail the greatest complexity, as the majority of variance in outcomes is attributable to patient and environmental factors that may not be readily modifiable. Selecting among structure, process, and outcome measures for quality improvement efforts generally will be dictated by the specific clinical situation for which improvement is desired.One aspect of health care quality that has received a great deal of attention in recent years is the relationship between surgical volume and health outcomes. Volume, an inherent characteristic of a health care facility or provider, is generally considered a structural measure of quality. Many studies have demonstrated a positive association between volume and outcomes, and policymakers in the private and public sectors have begun to consider volume in certification and reimbursement decisions. The volume-outcome association is not without controversy, however. Most studies in the field are limited by the nature of the administrative data on which they are based, and some studies have found that variation in quality within volume quantiles exceeds differences between quantiles. Moreover, regionalization driven by a focus on volume may exert adverse effects on access to care.The movement for health care quality improvement faces substantial methodological, clinical, financial, and political challenges. Despite these challenges, it is a movement that is gaining momentum, and the emphasis on quality in health care delivery is likely only to increase in the future. It is crucial, therefore, that physicians assume increasing leadership roles in efforts to define, measure, report, and improve quality of care.

Trends in Quality of Care and Barriers to Improvement in the Indian Health Service

“…Despite reporting substantial challenges to delivering care, a majority of physicians felt they were able to deliver high quality care. This divergence is likely related to physicians defining high quality care outside of the domains of care assessed in our study 28,29 .…”

Calidad en cirugía: hacia una mejor comprensión de las complicaciones quirúrgicas

“…Si volvemos a considerar que los resultados quirúrgicos interesan a muchos es fundamental, hoy, poder conocer y comparar éstos entre diferentes instituciones y en una misma institución en el transcurso del tiempo [45][46][47][48] . Sabemos que para ello debemos ajustar los resultados de acuerdo a los factores de riesgo y que, finalmente, están determinados por múltiples factores 49,50 .…”

Brief history of quality movement in US healthcare

“…Examples of structural measures include surgical case volume, access to technology and equipment, and provider to patient ratios. The association between surgical case volume and health outcomes is one that has received notable attention in recent years, with research that has revealed a positive correlation between volume and outcomes, and policy discussions have begun to consider volume in reimbursement decisions [48]. The advantage of structural measures in assessing quality hinges on the presence of readily available data usually collected in administrative databases and therefore access to large volumes of data, as well as the opportunity for rapid review of easily analyzed data [49].…”