Basic Concepts of Healthcare Quality

Definition-Related Concepts

A number of attributes can characterize the quality of healthcare services. As we will see, different groups involved in healthcare, such as physicians, patient, and health insurers, tend to attach different levels of importance to particular attributes and, as a result, define quality of care differently.

The following attributes relevant to the definition of quality of care:

  • Technical performance

Quality of technical performance refers to how well current scientific medical knowledge and technology are applied in a given situation.

  • Management of the interpersonal relationship

The quality of the interpersonal relationship refers to how well the clinician relates to the patient on a human level.

  • Amenities

The quality of the amenities of care refers to the characteristics of the setting in which the encounter between patient and clinician takes place, such as comfort, convenience, and privacy.

  • Access

The quality of access to care refers to the “degree to which individuals and groups are able to obtain needed services”.

  • Responsiveness to patient preference
  • Equity

Findings that the amount, type, or quality of healthcare provided can be related systematically to an individual’s characteristics, particularly race and ethnicity, rather than to the individual’s need for care or healthcare preferences, have heightened concern about equity in health services delivery.

  • Efficiency

Efficiency refers to how well resources are used in achieving a given result.

  • Cost-effectiveness

The cost-effectiveness of a given healthcare intervention is determined by how much benefit, typically measured in terms of improvements in health status, the intervention yields for a particular level of expenditure.

Measurement-Related Concepts

As Donabedian first noted in 1966, all evaluations of quality of care can be classified in terms of one of three aspects of care giving they measure:

Structure

When quality is measured in terms of structure, the focus is on the relatively static characteristics of the individuals who provide care and of the setting where the care is delivered. These characteristics include the education, training, and certification of professionals who provide care and the adequacy of the facility’s staffing, equipment, and overall organization.

Process

Process, which refers to what takes place during the delivery of care, also can be the basis for evaluating quality of care. The quality of the process in turn can vary on two aspects: appropriateness, which refers to whether the right actions were taken, and skill, which refers to how well actions were carried out and how timely they were.

Outcomes

Outcome measure, which capture whether healthcare goals were achieved, are another way of assessing quality of care.

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