What is Healthcare Quality?
Simply put, health care quality is getting the right care to the right patient at the right time – every time.
There are three basic dimensions to this: structure, process, and outcome. Structure represents the basic characteristics of physicians, hospitals, other professionals, and other facilities. It describes whether there are well-educated health professionals, appropriate hospitals, nursing homes, and clinics, as well as well-maintained medical records and good mechanisms for communication between clinicians. For example: Is the mammography equipment up to date and maintained properly? Are the cardiologists well-trained and board certified?
If the structure is solid, we can concern ourselves with the process of medical care. Concern for process suggests that quality is determined not just by having the right people and facilities available, but also by having the right things get done in the right way. Process includes questions like: Was the mammogram done for a woman at risk for breast cancer? Was the heart attack treated in the most up-to-date manner?
The third dimension, outcome, reflects the end result of care. Did people get better? What was the risk-adjusted mortality rate? Was disease or disability reduced or prevented? Was it reduced as much as it could have been, given what we know is scientifically possible? We need to be able to measure the outcomes of care so that we know which types of care really help patients and so that we can look to instances of poor outcome for opportunities for improvement.
Together, these components are the foundation of providing care that is consistently safe, timely, effective, efficient, equitable, and patient-centered. (IOM 2001)
The U.S. leads the world in biomedical advances and innovation. However, we do far less well in getting the right care to the right patient at the right time consistently. Moreover, the U.S. spends far more than any other nation, yet numerous studies have found that there is no relationship between high spending and care quality.
This is borne out by AHRQ data.
AHRQ is required to report to the Congress annually on the state of quality in the nation. Last year, according to statistics from AHRQ’s 2007 National Healthcare Quality Report (NHQR), the U.S. health care system continues to face challenges in improving the safety and quality of health care, ensuring access to care, increasing value for health care, and reducing disparities associated with patients’ race, ethnicity, income, education, or place of residence.
The National Healthcare Quality Reporttracks the health care system through quality measures, such as what proportion of heart attack patients received recommended care when they reached the hospital, or what percentage of children received recommended vaccinations. The Report is based on a framework established by the Institute of Medicine and is developed working with an interagency working group within HHS. It includes more than 100 measures culled from a wide-range of existing public- and private-sector data collection effort.
Overall, the quality of health care as measured by the quality indicators in our report improved by an average of 1.5 percent per year between the years 2000 and 2005, although this represents a decline when compared with the 2.3 percent average annual rate between 1994 and 2005. Quality indicators in some areas have improved, such as the percentage of patients who are counseled to quit smoking. For example, the percentage of patients receiving recommended care after a heart attack has increased more than 15 percent between 2002 and 2006. However, measures of patient safety, such as appropriate timing of antibiotics received by adult patients having surgery and inappropriate medication use by the elderly, showed an average annual improvement of 1 percent. In addition, the report reflects larger improvements associated with public reporting by providers of performance.
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