Health care quality

Health care quality is a level of value provided by any health care resources as determined by some measurement. As with quality in other fields, it is an assessment of whether something is good enough and whether it is suitable for its purpose. The goal of health care is to provide medical resources of high quality to all who need them; that is, to ensure good quality of life, to cure illnesses when possible, to extend life expectancy, and so on. Researchers use many different quality measures to attempt to determine health care quality, including counts of a therapy's reduction or lessening of diseases identified by medical diagnosis, a decrease in the number of risk factors which people have following preventive care, or a survey of health indicators in a population who are accessing certain kinds of care.

Definition and scope

Health professional perspective

The quality of the health care given by a health professional can be judged by its outcome, the technical performance of the care and by interpersonal relationships.

"Outcome" is a change in patients' health, such as reduction in pain, relapses, or death rates. Large differences in outcomes can be measured for individual medical providers, and smaller differences can be measured by studying large groups, such as low- and high-volume doctors.

"Technical performance" is the extent to which a health professional conformed to the best practices established by medical guidelines. The presumption is providers following medical guidelines are giving the best care and give the most hope of a good outcome. Technical performance is judged from a quality perspective without regard to the actual outcome - so for example, if a physician gives care according to the guidelines but a patient's health does not improve, then by this measure, the quality of the "technical performance" is still high.

History

The modern field of determining health care quality began in about 1970 and became a much greater topic of interest by the mid 1990s.

Areas for development

Some areas for development which have been proposed to improve the accuracy and research of measures of health care quality are the following:

• Identifying health care quality indicators
• systems for allowing patients to provide information into their medical records
• systems for better allowing patients to request their medical records
• standard algorithm for measuring quality
• standard system for reporting results
• development of public domain tool kits for use by physicians, administrators, and patient groups who want to participate in assessing and improving quality
• an international effort so that all countries participate in developing their own national quality reports
• for the 100 most common medical procedures, there should be a computer-based decision system which prompts physicians to ask patients standardized questions to decide whether to do a procedure, and this process should generate efficacy data

Identifying problems

Researchers measure health care quality to identify problems caused by over use, under use, or misuse of health resources. A study in the United States found that quality problems existed with equal frequency in both large and small communities.

Organizations which determine quality

Organizations which work to set standards and measures for health care quality include Government health systems; accreditation programs such as those for hospital accreditation, health associations, or those who wish to establish international healthcare accreditation; philanthropic foundations; and health research institutions. These organizations seek to define the concept of quality in healthcare, measure that quality, and then encourage the regular measurement of quality so as to provide evidence that health interventions are effective.

Organizations in the United States

The Centers for Medicare and Medicaid Services designs quality evaluations and collects quality reports because it manages funding for the central government Medicare and Medicaid programs. Agency for Healthcare Research and Quality (AHRQ) is a central government organization which collects public reports of health quality evaluation.

The Joint Commission is a nonprofit organization which accredits health care organizations and programs, and because this organization's accreditation influences the central government, its quality evaluations influence regional health care. The National Quality Forum is an organization which develops guidelines for evaluating quality.

Different organizations conduct the Consumer Assessment of Health Professionals and Systems (CAHPS) surveys by asking patients for their opinions on the quality of the health care services they receive. A range of related surveys ask people about their physicians, hospitals, health insurance, and other aspects of care.

Organisations in the United Kingdom

In the UK, healthcare is publicly funded and delivered through the National Health Service (NHS) and quality is overseen by a number of different bodies. Monitor, a non-departmental public body sponsored by the Department of Health, is the sector regulator for health services in England. It works closely with the Care Quality Commission (CQC) a government-funded independent body responsible for overseeing the quality and safety of health and social care services in England, including hospitals, care homes, dental and GPs and other care services.

Medical professions in the UK also have their own membership and regulatory associations. These include the General Medical Council (GMC), the Nursing and Midwifery Council, the General Dental Council and the Health and Care Professions Council. Other healthcare quality organisations include the Healthcare Quality Improvement Partnership (HQIP), a charity and limited company established by the Academy of Medical Royal Colleges, the Royal College of Nursing, National Voices; and Healthwatch, a statutory national body that works with groups across the country to ensure that patients' views are at the heart of decisions about the healthcare system.

A number of health think tanks, including the King's Fund, the Nuffield Trust and the Health Foundation also offer analysis, resources and commentary around healthcare quality. In 2013, the Nuffield Trust and the Health Foundation launched QualityWatch, an independent research programme tracking how healthcare quality in England is changing in response to rising remand and limited funding.

See also

• Evaluation & the Health Professions (journal)