Quality Assessment and Monitoring

Abstract

A commentary on the papers in the two special issues on Quality Assurance which shows how they contribute to some important conceptual, methodological, and policy issues. These issues pertain to the definition of quality; the distinction between quality assessment and program evaluation; the role of the market in regulating the quality of care; the role of more direct consumer participation in defining and assessing quality; professional responsibility for quality; the applicability of the structure-process-outcome paradigm to quality assessment; the format, methods of formulation, and validity of the criteria; probability sampling and purposive selection of the topics to be assessed; problems of scaling and measurement; the applicability of industrial control methods to quality monitoring; bringing about behavior change in response to the findings of quality monitoring; measuring the costs and benefits of quality assessment methods, including a consideration of their screening efficiency; and the relationship between quality monitoring and cost containment through competition or by other means.

Avaliação da oferta e utilização de especialidades odontológicas em serviços públicos de atenção secundária na Bahia, Brasil

“…Assim, foi constituído um comitê de três especialistas por área (cirurgia oral menor, periodontia e endodontia) quanto à opinião dos mesmos com relação ao número possível de procedimentos especializados a serem realizados por hora, totalizando a consulta a nove profissionais. O método utilizado para o consenso foi o método Delphy 23,24 , que garante o anonimato dos especialistas. Cabe destacar que todos eram especialistas atuantes na clínica e/ou professores das disciplinas relacionadas, portanto, com legitimidade para discorrer sobre a temática.…”

Avaliação do processo de atendimento a pacientes portadores de doença crônico-degenerativa em uma unidade básica de saúde

“…A avaliação do processo de trabalho não deve ser confundida com avaliação de processo, tal como proposta por Donabedian 3 . Embora seja possível identificar algumas semelhanças entre os respectivos meios de avaliação, tratam-se de perspectivas conceituais distintas que produzem, conseqüentemente, uma visibilidade diversa das ações de cuidado à saúde.…”

Interfaces Across the Cancer Continuum Offer Opportunities to Improve the Process of Care

“…This conceptualization allows us to begin classifying targets for intervention and demonstrates how manipulations of the care context could influence the overall process in a way that can be communicated and shared. Many have described relevant contextual factors including social and environmental conditions, care settings, and systems, as well as individual resources (6,7,19). The challenge has been to understand and conceptualize how these factors might affect care or guide improvement efforts.…”

“…Although the chasm between what we know and what we do in medical care was described by the Institute of Medicine at the turn of the millennium, systematic assessment of quality has been a concern for more than a generation (4-6). Donabedian (7) wrote about the complexities of health-care quality in the early 1980s and defined it as the ability of the care system to deliver the health benefits of treatments while reducing their adverse consequences. In this supplement, we explore the processes involved with comprehensive cancer care and emphasize the interfaces between providers, providers and patients, and health-care organizations.…”