definition of quality
Health care quality means that patients receive appropriate care for medical problems in order to achieve the best possible outcomes. Should be safe, effective, efficient, timely, patient-centered, and equitable. (IOM)
how do we acheive quality?
Practice Evidence-based medicine
What is evidence based medicine?
results from systematic research studies (randomized, blinded, placebo-controlled trials), clinical trials, and findings from other investigations used to guide medical decisions. Guidelines developed to help clinicians and patients make good decisions about medical care
Aspects of care (2) used to help determine quality
process and structure
What is structure (aspect of care)?
Structure refers to the setting in which care occurs and the capacity of that setting to produce quality. Traditional examples: credentialing, patient volume, and academic affiliation.
What is process (aspect of care)?
Process encompasses all that is done to patients in terms of diagnosis, treatment, monitoring, and counseling.Simply, are practitioners practicing care they way they are supposed to.
how are process structure and outcomes related?
Simply, are practitioners practicing care they way they are supposed to.
What are the 6 IOM Quality domains?
effectiveness, equity, efficiency, patient centerdness, safety, timelines
3 main process quality problems
misuse, overuse, underuse
overuse (and cost implication)
when a service is provided despite the likely harm outweighing the likely benefit. Also adds to individual and aggregated cost of health
underuse (and cost implications)
refers to the failure to provide a health care service when it would have produced a favorable outcome for a patient. Preventative is often less costly than complications which arise as a result of underuse
Usually we have underuse of primary care and adherence to chronic disease management
Misuse (and cost implications)
problems that should be avoidable: errors/complications, hospital acquired infections, etc. Increased cost due to preventable complications and potential legal liability