Health care can be judged as good to the extent that it increases the likelihood of desired health outcomes and is consistent with current professional knowledge (IOM, 1990). In practical terms, poor quality can mean
Quality care means providing patients with appropriate services in a technically competent manner, with good communication, shared decision making, and cultural sensitivity.
The first step in assessing quality of care is establishing which attributes of care are linked to optimal outcomes (e.g., survival, enhanced quality of life). Large, carefully designed clinical trials are usually necessary to establish which specific processes of care or treatments are effective. Early detection of breast cancer through screening mammography, for example, has been shown to reduce mortality significantly for women age 50 and older. Other types of research, notably health services research, also have a role to play in defining high-quality care. Next, observations of current medical practice—for example, through reviews of a sample of medical records—reveal the extent to which effective care is being applied. Measures of quality may assess structural aspects of the health care delivery system (e.g., hospital case volume), processes of care (e.g., use of screening), or outcomes of care (e.g., survival, quality of life). Each of these dimensions of quality could be assessed to provide complementary information.
More is known about the quality of care for breast cancer than for any other kind of cancer. Treatment of early breast cancer saves lives, and early detection through screening contributes to early diagnosis, when treatment is most effective. When established quality measures have been used to assess the care women receive, the following quality problems have been identified:
The consequences of these lapses in care are, in some cases, reduced survival and, in others, compromised quality of life.